Vocal cord surgery

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Chondrolaryngoplasty - removal of the Adam's apple and feminization of the voice

Since April 2020, the clinic has suspended accepting patients for an indefinite period.
We apologize. The Adam's apple very often causes a lot of trouble for transsexuals, but the solution to this problem is achieved by removing, reducing the size of the Adam's apple, or if complete removal of the Adam's apple is not possible, changing the angle of the thyroid cartilage to 120 degrees (female type) instead of 90 degrees (male type).

Why is it necessary to remove the Adam's apple during vocal feminization?

Direct feminization of the voice, i.e. Changing the timbre of the voice to a female one is achieved through a simple endoscopic operation to thin or shorten the vocal cords. Endoscopic surgery is most preferable due to its minimal invasiveness and gentle technique for patients.

However, the part of the larynx protruding on the front surface of the neck - the Adam's apple or Adam's apple - causes aesthetic dissatisfaction and psychological discomfort to patients.

Removing or reducing the Adam's apple (also called chondrolaryngoplasty or thyroplasty) effectively solves this problem. During this operation, the Adam's apple is trimmed - the front part of the thyroid cartilage and the throat is given a more feminine appearance:

To perform operations to remove the Adam's apple and feminize the voice, you need highly qualified personnel with experience in performing such operations and an ENT clinic well equipped with modern equipment. The operation must be performed with very high quality, since significant intervention in the structure of the larynx implies a significant change in the quality of the voice subsequently.

Before surgery to change your voice to a female voice, we always take x-rays of the thyroid cartilage and vocal cords and measure the exact distance from the vocal cords to the top of the Adam's apple. This way, we can remove as much tissue as possible from the Adam's apple without risking damage to the vocal cords.

As a result of the operation, the protrusion (Adam's apple) of the front surface of the neck is eliminated, the surgical scar is not noticeable and coincides with the natural folds of the skin.

Low-traumatic surgery on the ligaments will restore your voice and self-confidence

A pleasant voice attracts the affection of others. But not everyone is given this advantage by nature. And over time, formations may appear on the ligaments, further interfering with the clear sound of the voice. Fortunately, it is possible not only to return it, but also to change it through surgery.

Reasons for surgery on the ligaments

Surgical manipulations on the ligaments are possible for several reasons:

due to scars formed due to injury or after surgery on the larynx and neighboring organs;
for polyps, cysts, granulomas, nodes on them;
if necessary, restore conversational abilities reduced after tumor removal;
due to partial or complete paralysis of the ligaments;
due to age-related changes in voice modulation;
when it sounds rude to a woman;
when men's voices are too high.

In most cases, the need for surgery is purely medical. The patient needs to restore his voice, as it sounds too quiet, slurred, and becomes hoarse. And after a long conversation, you feel tired, which also affects its quality. This makes communication difficult and can interfere with the performance of professional duties.

But surgery can also be done if you simply don’t like your own voice. Rejection of its sound does not harm your health, but it causes psychological discomfort, which is not far from somatic diseases.

We recommend reading about laser septoplasty. You will learn about the indications for surgery, the technique of performing it, the rehabilitation period, and possible undesirable consequences. And here is more information about rhinoplasty of the tip of the nose.

Diagnosis of ligament condition

An examination for voice problems includes, in addition to interviewing the patient, the following manipulations:

Laryngoscopy . This is a visual examination of the larynx using a special mirror and laryngeal endoscopes. The doctor will pay attention to the shape of the ligaments, the color of the surface, and the features of the neoplasm, if any.
Stroboscopy . With its help, ligament movements, static areas, and unwanted changes in vibrations are identified. This is done thanks to light pulses directed at them.

Stroboscopy

Sometimes, for a more accurate diagnosis, a CT scan is prescribed and a biopsy of the tumor is performed.

Methods of performing surgery on the ligaments

The nature of the intervention depends on the problem at hand. It can be performed using a laser or surgical instruments. The use of an endoscope, laryngoscope, and microscope is mandatory. Typically, interventions are performed under general anesthesia due to the difficulty of accessing the ligaments. It is carried out through natural routes, without incisions.

To change your voice

It is possible to make the timbre higher or lower by transforming the chords. The doctor uses instruments to penetrate the larynx to the surgical field. If it is necessary to lower the timbre of the voice, notches are made at certain points of the ligaments. They lengthen and begin to vibrate differently during a conversation. Accordingly, the voice becomes lower.

Before and after ligament lengthening surgery

It is more difficult to transform the original timbre into a higher one. To do this, you need to shorten the ligaments. The procedure for changing them takes longer, it is important not to overdo it so that the voice does not become too thin.

Before and after laser plastic surgery of the ligaments. Blue stars indicate 2 seams; they will dissolve in 2-3 months. Before and after (after 6 months) shortening of the ligaments. The yellow arrow shows the place where the stitches were placed (they dissolved).

To improve your voice

Injection laryngoplasty will help improve your voice, get rid of hoarseness, and make it sound louder. It eliminates muscle atrophy and returns the ligaments to their previous appearance and function.

The intervention is carried out under the control of a laryngoscope. Using a long needle, the ligaments are filled with the patient's own fat tissue taken from other areas.

Sometimes collagen preparations and calcium hydroxyapatite are used as a graft. The ligaments are restored in volume, their elasticity improves, which leads to normalization of the sound of the voice.

But the effect will be present until the graft is absorbed.

Injection of calcium hydroxyapatite into ligaments

Another type of operation is performed for tumors on the ligaments. The resulting growths are removed using microsurgery, sometimes laser or radio wave radiation. If there is a need to get rid of part of the ligament tissue, replacement is carried out with implants.

For information about voice change surgery, watch this video:

Recovery after surgery on the ligaments

Rehabilitation after the intervention should last at least 3 months. It includes several conditions:

Inhalations The first 2 weeks or 10 days, especially if the operation was accompanied by the removal of formations, you need to remain silent. You can communicate with others using gestures, using paper and pen, or technology.
In the future, you also need to take care of your voice and talk less. Whispering or speaking in a raised voice should be avoided. In both cases, the load on the ligaments increases.
You cannot go to the bathhouse or swimming pool. During recovery, it is not advisable to inhale hot and humid air.
It is necessary to carry out the procedures prescribed by the doctor. This can be irrigation, inhalation, blockade with drugs, infusion of special cocktails.
Smoking is prohibited for at least the entire postoperative period. It’s better to give up the bad habit completely, otherwise problems with your voice will arise again.
You should also not drink alcohol. After a glass of wine, the voice seems to sound better, as the elasticity of the ligaments increases for a short time. But in fact, alcohol causes them to become dry.
Do not eat hot, spicy food. It irritates the mucous membrane, causing dryness.
Some time after the operation, you should go to a speech therapist. The specialist will teach you a conversation technique that will reduce the load on your ligaments.

We recommend reading about rhinoplasty to correct the nasal septum. You will learn about the causes and types of deformation of the nasal septum, diagnostic preoperative procedures, surgery, and the recovery period after. And here is more information about the rehabilitation period after rhinoplasty.

Preventing the development of ligament problems

It is better to try to prevent changes in voice, soreness, and the appearance of tumors on the ligaments than to treat and operate. Problems can be avoided if:

learn to speak loudly without straining your ligaments, which is facilitated by special speech techniques;
avoid high load on them for the first 2 hours after waking up;
avoid hypothermia and overheating;
carefully and completely treat pathologies of the larynx and respiratory organs;
drink plenty of fluids and gargle with soothing herbal infusions (chamomile, calendula, sage);
stop smoking and eating too much spicy food;
try to avoid staying in a smoky, dusty room.

A special role in the prevention of diseases of the apparatus belongs to special exercises:

Pronounce alternately the sounds “i”, “e”, “a”, “o”, “u”, stretching them out as much as possible. The exercise is done in front of a mirror and repeated 3 times.
Pronounce the sound “m” with closed lips. The first time they do this quietly, then louder, and in the end they increase the sound even more.
Touch the roof of your mouth with the tip of your tongue and growl, then exhale and make it stronger. The second part of the exercise should be to clearly pronounce words that contain the letter “R” (role, fish, fence, etc.).
Standing straight, inhale and as you exhale, make the sound “i”, knocking on your chest. Then do the same, pronouncing “e”, “a”, “o”, “u”.
From the same position, breathe rhythmically. Then take a deep breath, exhale sharply with the sound “ha”.

Sometimes you can restore your voice, give it sonority, or slightly change the timbre using conservative methods. But if they do not help, you should turn to surgery. A timely operation will not only restore your voice, but will also help to avoid more serious problems with the ligaments.

To see what exercises help relax the ligaments, watch this video:

Source: //PlasticInform.com/plasticheskaya-hirurgiya/golova-i-sheya/operatsiya-na-golosovyh-svyazkah.html

Adam's apple removal surgery

The operation is performed under general anesthesia.
A 2-4 cm wide incision is made at the level of the middle third of the thyroid cartilage, if possible along the natural skin fold.
After the incision, the thyroid cartilage is exposed to the perichondrium. It is important not to damage its internal part. The protruding, outer edge of the Adam's apple is removed to the required extent.
The extrinsic muscles of the larynx, running above and along the Adam's apple, are sutured over the operated surface of the cartilage.
A cosmetic suture and aseptic dressing are applied.

Indications for surgery

Sounds are formed when air moves through the closed vocal cords located in the larynx. The functioning of the ligaments is coordinated by the neuromuscular structures of the larynx, which are responsible not only for speech and vocal activity, but also for respiratory activity. Damage to the recurrent nerve of this part of the respiratory system (trauma, infection, inflammation, intoxication) impairs the mobility of the ligaments, causing their paralysis, loss of voice (partial or complete), difficulties with swallowing and breathing.

Voice formation (phonation) is often disrupted by scars formed in the larynx as a result of operations, burns (chemical or thermal), and prolonged intubation under general anesthesia. In this case, chronic narrowing of the larynx (stenosis) progresses, impairing the mobility of its cartilage. The closure of the vocal folds suffers, affecting the nature of their vibration.

Indications for phonoplasty may include the presence of singing nodules, polyps, cysts, granulomas, neoplasms, ligament paralysis or damage that reduces the aesthetic appeal of the voice timbre. In addition, surgical intervention is carried out at the request of the patient - to expand the vocal range or to acquire a more attractive voice, in his opinion. Before performing an operation, doctors examine the patient, determine the degree of his individual risk, and report possible consequences.

Postoperative period

As a rule, patients feel pain in the surgical area in the first days.
Hoarseness and weakening of the voice temporarily appear, which disappear during the healing process.
The dressing is changed daily to ensure good healing of the surgical wound.
The swelling gradually decreases. Stitches can be removed after 8-10 days.

If you still have questions about the operation itself or the capabilities of our ENT clinic, ask your question in the form of comments or call our clinic and qualified surgeons will advise you.