The thyroid cartilage is commonly known as the adam’s apple. It is typically larger and more prominent in those born male as the angle between the ala of the cartilage is more acute. Many of those seeking gender affirming care inquire as to reducing the size of the adam’s apple. This goes by many names, including thyroid cartilage reduction, tracheal shave, and chondrolaryngoplasty, and may be performed by a facial plastic surgeon or a laryngologist. This is a relatively simple procedure whereby a small incision is made on the neck and the upper aspect of the thyroid ala removed on both sides. The procedure is typically outpatient, meaning patients go home the same day. When performed correctly, this procedure does not alter the pitch of the voice; for that one needs a separate procedure. For more information, go to: https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/our-services/transgender-voice-feminization
Mark S. Courey, MD Chief, Division of Laryngology Director, Grabscheid Voice and Swallowing Center of Mount Sinai Vice Chair of Quality, Department of Otolaryngology Mount Sinai Health System
Diana N. Kirke, MD Assistant Professor, Otolaryngology, Head and Neck Surgery The Mount Sinai Hospital
Matthew C. Mori, MD Assistant Professor, Otolaryngology New York Eye & Ear Infirmary of Mount Sinai
Joshua Rosenberg, MD Co-Chief, Division of Facial Plastic and Reconstructive Surgery Mount Sinai Health System Assistant Professor Icahn School of Medicine at Mount Sinai
Mingyang L. Gray, MD Assistant Professor, Otolaryngology Mount Sinai Health System
Noah B. Sands, MD Assistant Professor, Otolaryngology Mount Sinai West
Zachary G. Schwam, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Division of Otology-Neurotology, Lateral Skull Base Surgery Mount Sinai Health System The Mount Sinai Oto Laryngology Surgical video series presents thyroid cartilage reduction, also known as a tracheal shave to minimize the profile of the atoms apple. This procedure is performed by our department, laryngologist and plastic surgeons often for patients seeking gender affirming care. This video was edited by Zachary Schwan. During the procedure, the patient has an L MA or laryngeal mask, air weigh in rather than an endotracheal tube. A flexible fiber optic scope is passed through the L MA to be able to see the larynx at all times. The scope sits in a custom built holder suspended above the table. A four centimeters incision is marked out over the patient's thyroid cartilage. A 15 blade is used to incise the skin, subcutaneous tissue and plasma muscle if present down to the level of the anterior jugular veins. Subplatysmal flaps are then raised inferiorly and then superiorly with a knife. Here. One can see the midline riffa and anterior jugular veins on either side, the FASA over the strap muscles are picked up with forceps to give counter tension and the tissue is split in the middle. The strap muscles were then raised off the laryngeal framework as shown on the left side, the thyroid cartilage comes into view. One can see the right and left thyroid ala and the thyroid notch in the middle, yellow hooks are used to retract the skin and soft tissue. Here is a slightly different view showing the two ala and notch. Posteriorly based perichondrium flaps are made bilaterally a mid light incision down to the level of the cartilage was made with a knife. A cry cook is used in the thyroid notch to retract the laryngeal framework over to the patient's right. The posteriorly based perichondrium flap is shown here. The arrow points to the direction in which it will be elevated. The cuts shown before are made with a knife. The perichondrium is then picked up with forceps while a cole elevator is used to elevate it posteriorly, the larynx is then retracted to the patient's left and the same cuts are made. The perichondrium is again grasped and elevated with a coddle. Now, on the right side, a knife is used to raise the last bit of perichondrium. An 18 gauge needle is stuck into the larynx to approximate the level of the anterior comma and the vocal cords. The needle can be seen with the endoscope perched in the airway. It is important to stay above this level when making the cartilage cuts. This level is marked with a bovie. The blue line marks the cartilage cuts and the hatched areas, the cartilage to be removed reducing the prominence of the thyroid cartilage gives the neck a more feminine appearance. The cartilage cuts are then made with a knife and the cartilage is elevated off the paraglottic space and epiglottic space with a coddle elevator. It is important not to violate these spaces. The cartilage cuts are now made on the right side and again elevated with a coddle a bit more is trimmed from the left to even things out. One can now see the thyroid cartilage remnant in the two aforementioned spaces. The midline thyroid cartilage remnant is then whittled down a bit to smooth out the edges. The perichondrium on the right is then sutured to the pre epiglottic space and epiglottic P O as well as the left perichondrium with one vil suture. The strap muscles are reapproximated with viral, deep dermal sutures are placed and a running subcuticular monocryl is then performed. Dermabond is applied to the skin and the monocryl is cut. Sterry strips are then placed on top of the derma bond.