Transvestibular Chondrolarynoplasty-Experimental Study in Cadavers.

Abstract

Background: The neck, and specifically the prominence of the thyroid cartilage, can be considered a marker of male gender, which is often unwanted by transgender women. Chondrolaryngoplasty is traditionally performed using an open transcervical approach, which, while effective, leaves visible scars that can compromise patient satisfaction. Recent advancements, such as the transoral endoscopic vestibular approach (TOEVA), have emerged as promising alternatives, eliminating external scars and improving esthetic outcomes.

Methods: Endoscope-guided transoral buccal dissections of five human cadavers' necks were performed to visualize and expose the thyroid cartilage, followed by the chondrolaryngoplasty procedure by the same route. The technique involved three oral vestibule incisions for trocar placement, subplatysmal dissection, and resection of the thyroid cartilage prominence using laparoscopic instruments. A specially designed endoscopic rasp was utilized to refine cartilage contours.

Results: Chondrolaryngoplasty using a transoral approach proved feasible, allowing the thyroid prominence to be reduced without an apparent scar. Visualization and instrument manipulation were successful in three cases, with adaptations required in two cases due to rigor mortis altering anatomical positioning. Complications included two minor skin perforations and instrument breakage in a case with calcified cartilage, necessitating alternative tools. There were some complications related to cadaveric phenomena.

Conclusion: Performing the procedure on cadavers presented some limitations related to cadaveric phenomena, such as skin stiffness and loss of elasticity, as well as difficulties with mobility, making the surgical procedure difficult. Despite these challenges, the procedure achieved satisfactory esthetic outcomes, with precise cartilage reduction and no visible scars. The procedure proved to be viable, achieving the goal of reducing the prominence of the thyroid cartilage while avoiding an apparent scar. Further clinical studies are suggested.