Facial Plastic and Reconstructive Surgery Fellow WardMD Facial Plastic Surgery, Utah
Background: Chondrolaryngoplasty is performed in transfeminine patients who are seeking gender affirming surgery to feminize the appearance of their neck.
Oftentimes, only so much of the thyroid cartilage may be reduced before the delicate vocal fold attachments become compromised. Cricoid augmentation with a free graft from the thyroid cartilage and muscle repositioning allows for feminized neck contour with minimal added risk.
Study Objectives: Herein we describe our modified technique of cricoid augmentation chondrolaryngoplasty and report on the incidence of hoarseness and overall satisfaction amongst our patients with their cosmetic appearance.
Method: The incision is made in either the cervicomental crease or superficial to the thyroid cartilage. The infrahyoid muscles are divided in the midline. The thyroid cartilage is identified and the outer perichondrium elevated. A direct laryngoscopy is then performed and the glottic location on the thyroid cartilage is marked to ensure the vocal cords are not injured in the process of excision.
A safe portion of the thyroid cartilage is directly excised. The excised cartilage is used as a free cartilage graft to augment the cricoid cartilage in order to form a more feminine laryngeal contour.
The platysma is then employed to cover the thyrohyoid and cricothyroid membranes to provide further augmentation and feminine contour.
Conclusions: Herein we describe a new technique of cricoid augmentation chondrolaryngoplasty performed in transgender patients to enhance the contour of the neck. None of our patients who underwent this modification experienced postoperative hoarseness and the vast majority were very satisfied with the resultant cosmetic outcome.