Discussion
Spiegel7, in a retrospective study, indicated that
60% of the 31 patients who underwent chondrolaryngoplasty were ”very”
or ”completely” satisfied. In our sample, all patients demonstrated
aesthetic satisfaction after surgery, whereby 80% of the VAS scores
were between 9 and 10. We introduced the use of the diamond burrto
flatten the remaining thyroid cartilage, thereby enabling major
remodeling without a temerarious resection,perhaps one of the key points
for surgical success.
It was demonstrated, prospectively and objectively, that there was no
permanent vocal change in any of the patientsduring the postoperative
period. Two patients reported hoarseness in the first week, possibly due
to transient laryngeal edema from surgical manipulation or even by
orotracheal intubation, which was resolved itself without the need for
any specific treatment. The variation observed in the F0 and in the
GRBAS had no statisticalsignificance and is probably part of the daily
changes within the normal range of each individual.8
Chondrolaryngoplasty represents a challenge for the surgeon in seeking a
balance between aesthetics and function: a very conservative resection
of the thyroid cartilage may lead to aesthetic dissatisfaction, while
excessive resection may destabilize the anterior commissure tendon,
thereby signifying permanent vocal damage, with hoarseness and decrease
in vocal pitch, which would be tragic for a transgender woman.
Spiegel5, in 2008, described a surgical approach using
a laryngeal mask airway combined with intra-operative fiberoptic
laryngoscopy examination to mark the implantation height of the anterior
commissure in the thyroid cartilage with a 22-gauge needle, and
consequently at the safe limit of the resection of the thyroid
cartilage.In our study, the midpoint of the height of the thyroid
cartilage was used as a parameter for insertionof the anterior
commissure, with an additional safety margin of 3 mm. This parameter had
already been employed since Isshiki type I thyroplasty and was
objectively measured by Sagiv9 in 2016. It proved to
be simple, easy to perform and safe. Furthermore, unlike Spiegel’s
technique, it can be executed under general anesthesia with endotracheal
tube, especially when performing another sex reassignment
proceduresimultaneously.
This study has several limitations. Initially, the number of
participants was small, and might not have reliably represented the
population. Secondly, due to the study design and ethical aspects, it
was not possible to establish a control group to eliminate the influence
of the placebo effect. Moreover, there was no objective measurement of
the laryngeal prominence before and after surgery, demonstrating in fact
that there was a significant reduction.