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Improving Safety In Chondrolaryngoplasty
Hossein E. Jazayeri, DMD, Megan Lane, MD, Alec Khouri, MD, Nusaiba Baker, PhD, Shane D. Morrison, MD, MS, William M. Kuzon, Jr., MD, PhD, Paul S. Cederna, MD, Robert H. Gilman, MD, DMD.
University of Michigan, Ann Arbor, MI, USA.

Improving Safety in Chondrolaryngoplasty
Hossein E. Jazayeri, DMD; Megan Lane, MD; Alec Khouri, MD; Nusaiba Baker, PhD; Shane Morrison, MD, MS; William M. Kuzon, Jr., MD, PhD; Paul S. Cederna, MD; Robert H. Gilman, MD, DMD
Purpose:
The authors present a series of facial feminization surgery (FFS) patients undergoing chondrolaryngoplasty with a description of the technique performed by the senior author (RHG). The purpose of this study was to adapt multiple safeguarding steps including preoperative CT to measure vocal cord insertion point and length of planned resection with needle localization intraoperatively to confirm position. Secondarily, the purpose is to elucidate patient demographics and outcomes, and to describe a surgical technique.
Methods:
The University of Michigan Institutional Review Board application was approved. Clinical charts from 2012 to 2020 were queried for all patients who had undergone chondrolaryngoplasty by three attending surgeons: WMK, PSC, and RHG. Patient demographics were included, such as age, race, and smoking status. Other variables included operative length, other procedures performed, readmission, reoperation, length of stay, BMI, opioids prescribed, and medical and psychiatric comorbidities. Descriptive statistics were performed. Secondarily, a novel technique for this procedure by RHG was described.
Results:
Case Series:
Twenty-seven patients met the inclusion criteria. The average age of the cohort was 32.78 (+/- 12.3). The mean BMI was 23.81 (+/- 4.84). Twenty-three patients were Caucasian (85.2%), two patients were African-American (11.1%), one was Hispanic (3.7%), and one did not respond (3.7%). Twenty-six patients were non-smokers (96.3%). Twelve patients underwent chondrolaryngoplasty alone (44.4%), while 9 received concomitant facial feminization (33.3%), 3 received penile inversion vaginoplasty (11.1%), and 3 received breast augmentation (11.1%). Three patients experienced minor postoperative complications (11.1%). The
mean length of stay was 1.22 days (+/- 0.97), while the mean operative time was 148 minutes (+/- 89.54). Five patients experienced depression (18.5%), five experienced anxiety (18.5%) and five experienced other mental conditions (18.5%). Two patients had diabetes mellitus (7.4%) and two were hypertensive (7.4%). Three had respiratory disease (11.1%) and eight experienced other conditions (29.6%). The mean number of opioids tabs was 29.26 (+/- 21.6) with a mean refill of 0.11 (+/- 0.42).
Technique:
Prior to the reduction of cartilage, a laryngoscope is inserted by the Anesthesia team to confirm the location of vocal cord attachment. A 25 Gauge needle (1.5 inch) is inserted at the most inferior portion of the planned reduction and the position of the needle relative to vocal cord attachment was visualized. The level at which the needle is inserted is marked as the most inferior portion of reduction on the thyroid cartilage. A 5-mm round power diamond bur is then used to shave the cartilage at the thyroid notch, with care taken to not go past the marked inferior border (2-3 mm). Burring is complete at detection of a smooth contour of the notch on external examination.
Conclusions:
Chondrolaryngoplasty in the University of Michigan FFS population has been safe and effective, indicated by minimal complications and patient satisfaction.


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