Open Feminization Laryngoplasty, Cricothyroid Approximation (CTA), Thyroplasty type IV.
The goal of the voice feminization surgery is to raise both the fundamental and the resonant frequency of the vocal tract in male to female transgender patients.There are some differences between pitch, voice and speech. The vocal cords are like a sound generator and the individual pitch depends on the frequency of the vocal cords vibration. The size and shape of our throats, mouth, nose and sinuses gives the voice differences. The movement of the lips, teeth and tongue transforms the voice into words and sentences that we call speech.The speech is controlled by the brain to express feelings, thoughts, emotions etc. So speech practice is very important for a successful voice surgical result and comfortable speaking, that’s why the speech practice can only be taught by an experienced transgender voice speech therapist.
Stop smoking at least 2 weeks before the surgery. Before any thyroplasty surgery, a careful videolaryngostroboscopic and spectrum-acoustic study of the voice is performed on each patient, in order to better plan the surgery and evaluate the post-surgical results.The examination long lasts one hour, including the procedure discussion, alternative treatment, risks,questions and answers. After the first evaluation, the patient will spend one hour, 2-3 times per week, with the speech therapist to reeducate the voice to its natural speech.
|Picture 1 Crico-Thyroid||Picture 2 Vocal Tract|
Picture 3 Shows vocal cords
The goals of this operation has to surgically move closer the thyroid cartilage to the cricoid one, with non-absorbable stitches, so that vocal cords are not touched but passively stretched. This procedure results increase vocal picth by stimulating the contraction of cricothyroid muscle with the suture. It increase the distance between the vocal fold acttachments and raise the tension of vocal fold. The cricoid and thyroid cartilage is approximated as closely as possible because post operation reversnion to ward a lower picth to some extent is inevitable. The fundamental frequency of the voice to rise up to perceptively overlap the biological female one. The operation is performed under general anesthesia. Duration time is about 40-50 minutes and the surgical reduction of Adam’s apple can be performed at the same time. Generally, the patient doesn’t feel any post operation pain, however pain may occurs if the Adam’s apple surgery is accomplished. In any case the pain is mild and perfectly controllable with painkillers.
A transverse incision scar is made in and exising skin crease, if possible at the level of vetical midpoint of the thyroid cartilage on the throat, which is a small surgical opening, around 2 cm, leaving an almost invisible scar
Picture 4 Shows before and after vocal cords
- This procedure dose not interfere or create scar on the vocal cords which can lead to permanent hoarseness
- Theoretically reversible if the patient is dissatisfied
- The surgical reduction of Adam’s apple can be performed at the same time
- Requires neck incision
- Longterm results are inconsistant
- Day 1 to 7: Absolute silence until the first follow up. There are no food and drink restrictions.
- Day 3 to 7: Moisturize the vocal cords by drinking enough water,nebulize with a sterilized saline solution. Top of Form
- Day 8 to 10: After the vocal rest period, a new videolarygostroboscopic and spectrum-acoustic study is performed, the outer stitches are removed, the dressing is performed and the speech therapy rehabilitation can start.
The speech therapist will teach to the patients how to use her new voice in the best way possible. The final result will be seen between the third month and the eighth month after surgery. For this reason a follow up is recommended at the third, sixth, twelfth month, after surgery.
Note: The surgical team reserves the right to assess the feasibility case by case if the upcoming patient already underwent the voice change surgery using a different technique and is not satisfied with the result of his / her voice
In order to prevent acid reflux it’s highly recommended to avoid caffeine, chocolate, peppermint, fatty foods, acidic foods, sodaand alcoholic drinks.
Work and activity: one week off from work is sufficient as long as it’s possible to follow the voice restrictions. Two weeks off from work are required if the use of voice is demanded.
Female to male voice surgery or voice masculinization:
This type of surgery is performed if the patient is not satisfied with his voice despite the use of the male hormone therapy that, unlike the female one, lower the fundamental frequency of the voice.
Before the surgery, an accurate videolaringostroboscopic and spectrum-acoustic study of the voice is performed to highlight its real fundamental frequency and to plan the best operation in line with the patient needs.
In this case the surgical intervention consists of an increase in the mass of the vocal cards through an intra-cords injection of biocompatible material (from autologous fat to hydroxyl-apatite depending on the cases).To the increase vocal cords mass, follows a lowering of the voice fundamental frequency, as desired by patient. The operation is performed under general anesthesia and its duration is about 20- 30 minutes. The patient generally does not experience any pain after surgery and feeding has no limitations.
After the surgery there is a mandatory period of silence of about two days. A new videolaringostroboscopic and spectrum-acoustic study is then performed to evaluate the new fundamental frequency and afterwards the patient can start talking again, always with the help of speech therapist.
As usual, only one injection of biocompatibility material is sufficient, but the biological re-absorption of the injected material is individual and not predictable in each case. Regularly the male voice duration long lasts some years and in any case this operation is perfectly repeatable.