External incision or scarless - which tracheal shave method is safest?

Question

I am currently considering tracheal shave. My concern is, however, the potential for damaging my vocal cords. I have a naturally feminine cis, gendered voice, and I want to make sure that I preserve it. I have consulted with doctors, some do the scarless method and others do the external incision. All tout their method to be the safest and the gold standard so I am not sure who to believe. I know it all comes down to surgeon skills, but objectively and medically speaking, which is safest?!

Jacob Tower, MD · Answer

Hello, hope you are well. In general, the better exposure a surgeon has to perform a task, the better the outcome will be and the lower the risk profile. The open approach (external incision) trach shave has been yielding good results for decades and is inherently safer than 'scarless' chondrolaryngoplasty. Chondrolaryngoplasty is a relatively low risk procedure in any case, but introducing an endoscopic approach results in increased surgical and anesthesia time, and other potential risks like mental nerve injury, injuries to the skin flap, chin and neck adhesions, CO2 embolism, etc. As you said, it does come down to an individual surgeon's skill and technical ability, but a skin incision approach is inherently safer.

Best,
Dr. Tower

Best,
Dr. Tower

Toby Mayer, MD · Answer

Tracheal shave, which is the safest and most effective? Based on my 50 year experience doing this procedure, I feel that the External skin incision gives the safest and most effective result. His procedure involves a 1 inch incision which will be barely noticeable done at the junction of the vertical neck with the Horizontal is easily hidden and should be a fine line. Other approaches very often leave and inadequate result and less exposure. See a very experienced surgeon for the best result.

Stephen Kleid, MBBS, FRACS · Answer

Reduction laryngoplasty is not a "tracheal shave". The Thyroid prominence ("Adam's Apple") is trimmed. This is well above the trachea, which is not touched during the operation.With the open (neck incision) technique, nothing needs to be shaved, the cartilage is trimmed with a scalpel, and if there is a bony component, it is cut with a small surgical saw.I have done about 35 of these open operations - the scar heals well, hidden in the chin/neck crease, and I believe it is safer. I have had no problems in any cases.With the trans-oral techniques, where the scar is hidden inside the mouth, usually a long drill is used to shave back the laryngeal prominence, and I am sure there must be a tiny risk of bleeding that is not easy to control due to limited access, or of vocal cord damage.

External incision or scarless - which tracheal shave method is safest?

Answers (3)