Will a tracheal shave compromise my voice feminization surgery?

Posted on August 11, 2017 by Ellen Defrancq
Tracheal shave and voice feminization surgery
A tracheal shave is a procedure often performed during facial feminization surgery. The following question is frequently asked in respect to a tracheal shave and the voice: Will a tracheal shave compromise my voice feminziation surgery outcome?

A tracheal shave will not compromise the outcome of your voice feminization surgery if 2 important structures are not damaged during your tracheal shave:

  • The vocal cords themselves
  • The muscles around the voice box (Extralaryngeal muscles)

 

Vocal cords

Obviously damaging the vocal cords during a tracheal shave doesn’t help in getting a feminine voice. The cords would lose tension, the pitch would fall and the voice would become raspy.

Below you can see a plastic model showing the part of the thyroid cartilage that forms the Adam’s apple. The white lines show where the cartilage needs to be cut before being removed.

Tracheal shave and voice feminization surgery frontal view of voice box

Plastic model showing the part of the thyroid cartilage that forms the Adam’s apple. The white lines show where the cartilage needs to be cut to be removed by a tracheal shave.

The next picture shows the same white lines on the inside of the cartilage and the relation to the vocal cords (white folds) that are just below.

This picture shows the same white lines on the inside of the cartilage and the relation to the vocal cords (white folds) that are just below.

 

To be sure that the vocal cords will not be damaged during a tracheal shave it is essential to know how much of the cartilage can safely be removed. For this reason we at 2pass Clinic make a CT-scan of the Adam’s apple the day before surgery and measure precisely how much of the cartilage can be removed. In about 90% of cases the Adam’s apple can be made invisible by means of a tracheal shave, in 10% this is impossible because the voice cords would be damaged.

CT scan before tracheal shave

The muscles around the voice box

Muscles on the outside of the voice box cartilage, such as thyrohyoid muscle and sternothyroid muscle, must not be damaged during surgery. The voice box cartilage is not stiff bone but flexible cartilage (like the one that gives your ears shape).  By altering the form and position of the voice box these muscles help to increase your pitch and they also give you an important resonance control.

Dr Yeson did an investigation and patients with damaged muscles had 20Hz less pitch if these muscles are damaged. During a tracheal shave Dr Bart van de Ven gently pushes the muscles aside without damaging them, so you can have your voice feminization surgery afterwards without compromise.

Below these muscles are indicated with a blue shading. During a tracheal shave Dr van de Ven will search for the thyroid cartilage in the midline first and then carefully push these muscles aside to make sure they will not be damaged.

Tracheal shave an yeson voice feminization surgery

The muscles important for moving the voice box are indicated with the bleu shading. During a tracheal shave it is important not to damage them.

The technique used by 2pass Clinic is perfectly compatible with your voice feminization surgery at the Yeson voice centre. Dr Bart van de Ven and Dr Kim from Yeson Voice Center had contact to make sure their techniques are compatible.

Operations after your voice feminization surgery

After a voice feminization surgery it is important the shortened voice cords are not damaged during intubation for other surgeries you might have in general anesthesia. Ideally a 5.5 diameter airtube should be used by the anesthesiologist. For longer operations this can be problematic because air has to come in with more force because the tube is smaller. It depends on the anaesthesiologist insights if he thinks your lungs and body are healthy and can have it. For shorter operations this is not so much of an issue and the small 5.5 airtube can be used. Discuss this with your anaesthesiologist before every operation.

When should I plan to have my voice feminization surgery?

For the above mentioned reasons ideally your voice cord surgery is the last surgery of your transition. At least big surgeries like SRS and FFS should have been performed prior to your voice cord surgery.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.








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