Recent internet postings report that Bruce Jenner is purportedly planning on reducing the size of his Adam’s Apple, an operation known as as tracheal shave. These reports also state that this neck operation is typically performed on patients in the initial stages of gender reassignment surgery. While I have no idea whether Bruce Jenner has any interest in this operation or not, it is not true today that those who seek a tracheal shave are in some phase of male-to-female transformation.
A tracheal or laryngeal shave, technically known as a chondrolaryngoplasty, reduces the central bulge in the neck caused by the size of the thyroid cartilages. This is created by how large the paired thyroid cartilages are which come together in a V-shaped configuration surrounding the vocal cords, hence it is often called the voicebox. Males typically have larger thyroid cartilages due to the growth influence of the male hormones.
A tracheal shave is done through a small horizontal incision overlying the largest prominence of the thyroid cartilage. It is usually no bigger than 3 to 3.5 cms. Once past the skin, the vertical strap muscle of the neck are separated to expose the cartilage. It is not a very far distance from the skin to the cartilage as one can tell by feeling their on neck. The cartilage is then literally shaved down with a scalpel, reducing the V-shaped prominence. In layers, the tissue is then closed over the reduced cartilages with dissolveable sutures for the skin.
A tracheal shave procedure can be done in less than one hour under either local or general anesthesia. Because of the potential risk of damaging the vocal cords and changing one’s voice, some surgeons prefer to do the reduction under local anesthesia. By so doing one can hear the patient’s voice or use a laryngoscope to locate the vocal cords by a percutaneous needle. Other surgeons, including myself, use IV sedation or general anesthesia and use judicious reduction to prevent vocal cord injury or change. While protection of the attachments of the vocal cords is important, they are usually below the level of the cartilage reduction.
While many people think this neck procedure is done only in transgender patients, it is not. That may be its history, but most of the patients that I do tracheal shaves on today simply want an unnaturally large Adam’s Apple reduced. These are often men with little subcutaneous fat in their necks and a very visible thyroid cartilage bulge that is unnaturally prominent.
Dr. Barry Eppley