(507) Transoral Chondrolaryngoplasty: Safe, Effective Gender-Affirming Surgery in an Adolescent-Young Adult

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Has Audio

Presenting Author(s)

Patrick T. Kiessling, MD

Resident Physician
Stanford University
Stanford, California, United States

Co-Author(s)

BN

Brian A. Nuyen, MD

Otolaryngology-Head and Neck Surgery
Stanford Medicine
Portland, Oregon, United States
Karthik Balakrishnan, MD

Surgeon-in-Chief
Department of Otolaryngology, Stanford University
Stanford, California, United States
JN

Julia Noel, MD

Stanford Medicine
Stanford, CA, USA

Senior Author(s)

Kara D. Meister, MD

Clinical Assistant Professor
Stanford Medicine
Stanford, CA, United States

Disclosure(s):

Patrick T. Kiessling, MD: No relevant relationships to disclose.

Brian A. Nuyen, MD: No relevant relationships to disclose.

Karthik Balakrishnan, MD: No relevant relationships to disclose.

Kara D. Meister, MD: No relevant relationships to disclose.

Introduction
Chondrolaryngoplasty (“tracheal shave”) is a procedure performed for transgender females to feminize neck appearance. However, this procedure is poorly characterized in the adolescent-young adult population, especially when considering the transoral approach. Here we report the case of a 20-year-old transgender female who underwent successful gender-affirming transoral chondrolaryngoplasty, demonstrating the safety and effectiveness of the procedure in this population.
Methods
This case report evaluates the otolaryngologic care provided to an adolescent-young adult transgender female patient from 2021 through 2022, as part of a multidisciplinary gender clinic at a children’s hospital. Alongside a review of literature, this case details the surgical techniques implemented in transoral chondrolaryngoplasty, with the aesthetic and functional outcomes achieved as part of this patient’s gender transition.
Results
Following microdirect laryngoscopy to assess the airway, a suture was passed into the airway transcervically just above the level of the vocal folds and pulled out transorally to mark the inferior-most point of safe cartilage removal. The patient was transnasally intubated, and ports were placed via incisions in the central lower lip and laterally on both sides at the wet-dry lip junction to gain access to the thyroid cartilage. An arthroscopy shaver was used to shave down the anterosuperior aspect of the thyroid cartilage, rounding the contour to achieve the desired appearance while preserving the structural integrity of the larynx. In the week following surgery, the patient demonstrated normal voice and airway function, and was very pleased with her neck appearance, saying it made her feel “liberated.” At 6 month follow-up, she had sustained satisfaction with the results.
Conclusions
This case demonstrates the safety and effectiveness of transoral chondrolaryngoplasty in an adolescent-young adult, confirms the role of otolaryngologists in providing comprehensive care for this patient population, and asserts the need for further study of these gender-affirming interventions.