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Thyroid cartilage (Adam’s Apple) is an important masculine characteristic. It is quite troublesome for women with obvious appearance of thyroid cartilage or those who want a feminized neck. When the thyroid cartilage is shaped in adulthood, even transgender hormone therapy could not reshape the cartilage. Therefore, surgery becomes the only solution. 

In the past, most thyroid cartilage reduction was performed via an external incision wound. Although the wound was mostly hidden at the junction of the chin and neck, the scar could still appear through neck activities

Today, patients can choose the scarless thyroid cartilage reduction to implement the surgery through odontoscopy. The surgical horizon adds precision to the surgery and conceals the scars in the oral cavity, so to soften the protruding cartilage. The post-surgery recovery is fast and hence the scarless thyroid cartilage reduction will be the new choice.

Indication of Surgery

• Make the appearance of protruding cartilage smoother and milder through surgery.

Objectives and Modes of Surgery

• Wound position: Border between under the oral cavity and teeth.
• Aesthetics: General anesthesia
• Surgery Hours: Approximately 4-6 hours.
• Surgery Goals: The edge of thyroid cartilage is smoothened to lower the masculine characteristics of appearance.

Post-Surgery Care

• The elastic band will be used for one week to help the adhesion of the soft tissue under the chin.

Advantage and Disadvantage of Surgery

• Advantage: Reducing the likelihood of scars from surgery.
• Disadvantage: Longer surgery hours and could lead to complication.

Possible Complications

• Hoarse voice or phonasthenia: Could be related to the removal of excess thyroid cartilage. To reduce such risk, the endoscopy will be used during the surgery to identify the position of vocal cord.
• Subcutaneous emphysema: The subcutaneous injection of carbon diode helps establishing a working space but may not avoid some spillover to the neck or the upper chest skin, resulting in aches. Usually the condition will recover in one week after the surgery.
• Post-surgery Ecchymosis: Takes about one month to recover.
• Abnormal sensation on lower lip: The mandibular alveolar nerve would be pulled during the surgery while patient perceive the abnormal sensation after surgery. About 90% of patients will improve the conditions no later than 1 year after the surgery.

Plastic and Reconstructive Surgeon: Dr. Pin-Keng Shih

China Medical University Hospital (Taipei, Hsinchu, Taichung)