Endoscopically facilitated reduction laryngochondroplasty.

Endoscopic verification of the level of excision of the thyroid cartilage in reduction laryngochondroplasty maximizes the aesthetic result of the operation and prevents possible injury to the vocal cords. A prominent thyroid cartilage is identified with male sex. Reduction of the thyroid cartilage prominence (Adam's apple), also known as laryngochondroplasty, is often requested by patients undergoing male-to-female transsexual surgery. Some women, and even occasional slender men, with a markedly pronounced thyroid cartilage prominence also request this treatment to refine their neck contour. Topographic studies place the true vocal cords at a level corresponding to halfway up the thyroid cartilage. Because of the proximity of the thyroid cartilage prominence to the attachment of the true vocal cords, any anatomic variation may lead to injury to the phonatory apparatus during the cartilage excision. Attempts to avoid this occurrence may result in overconservative reduction of the thyroid prominence and less-than-optimal aesthetic results. Herein we describe a combined endoscopic and external surgical approach to reduction laryngochondroplasty.