Modification of Wendler Glottoplasty for Male to Female Gender Transition.

Abstract

Transgenderism is a condition regarding the gender identity of an individual where their psychological gender is discordant with their anatomic gender. For patients transitioning from Male to Female, voice changes are created predominantly with voice therapy, with vocal surgery as an adjunct if the patient desires it. A common surgical technique is the Wendler Glottoplasty. A CO2 laser is used to de-epithelialize the anterior third of the vocal folds and the anterior one-third of the folds are sutured together. This shortens the vibratory folds and increases the fundamental frequency (F0) of the voice. We present a novel modification that incorporates use of injectable aqueous carboxy-methyl-cellulose gel (Prolaryn) to medialize the anterior aspect of the vocal folds and apply fibrin glue sealant (Tisseal) in lieu of sutures, simplifying the operative technique and a thyroarytenoid myectomy for debulking of the cords in select cases. We present ten patients treated with our modified Wendler Glottoplasty technique. Voice assessment was based on F0 and frequency range pre and post-operatively measured via MDVP and Real-Time Pitch on the Computerized Speech Lab. The 10 patients had an average age of 34.0 years (range 22.2-64.3 years). The average preoperative F0 was 136.1 Hz, with an average frequency range of 108.3-282.4 Hz. Postoperatively, the average F0 was 245.9 Hz, with an average frequency range of 197.3-300.7 Hz. This led to an average F0 increase of 106.3 Hz. Our modification to the Wendler Glottoplasty successfully resulted in a significant increase in the postoperative F0. In addition, there was improved satisfaction in vocal character after the procedure, compared to their preoperative vocal character.