Surgical techniques and outcomes of thyroid chondroplasty in transfeminine individuals: A systematic review

Abstract

Thyroid chondroplasty (TC) in facial gender affirming surgery (FGAS) is aimed at modifying the thyroid cartilage to achieve a more feminine laryngeal appearance. This study evaluated open versus endoscopic techniques to thyroid chondroplasty and associated outcomes and complications. A systematic review (SR) according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines for articles pertaining to TC was conducted. Data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) was reviewed for individuals who underwent “cervical tracheoplasty” for gender dysphoria. In the SR, 12 articles representing 368 patients were included for analysis. Nine articles described open approaches and three articles described endoscopic techniques. Rate of total complications was found to be 4.3% (n=12) in the open approach compared to 15% (n=13) in the endoscopic approach. Reports of positive aesthetic results was 92% for the open approach and 90% for the endoscopic approach. In the open approach, seven (2.5%) patients requested additional removal of cartilage and three (1.1%) requested scar revision. In the endoscopic approach, three (3.7%) patients requested additional cartilage removal in the endoscopic approach. NSQIP database found no incidence of wound or major complications among patients who underwent tracheoplasty alone. While the advantage of the endoscopic approach is a scarless neck incision, the rate of complications for endoscopic thyroid chondroplasty is higher than the open approach. Endoscopic approaches are still not widely used and continued investigations are warranted to improve familiarity of this approach and reduce postoperative complications.