Reduction of a prominent Adam’s apple is a neck contouring procedure that is known as a tracheal shave or, technically, a chondrolaryngoplasty. It is a very effective procedure that is most commonly done through a small skin incision directly over the tracheal prominence. Through this approach the elevated ridges of the thyroid cartilages are literally shaved down using a scalpel and occasionally a rotary burr if the cartilage is very stiff or ossified.
The skin incision in the neck for a tracheal shave is positioned in a horizontal orientation. As a result it usually heals exceptionally well, often being virtually invisible. But in some patients who have concerns about the neck scar for a tracheal shave, there is an alternative incision location.
A submental approach can be taken for the neck contouring procedure. Through an inch long incision in the submental skin crease, a skin flap can be raised down to and over the tracheal prominence. It is some distance away but the elevation of such a skin flap in the neck is common, frequently done as part of many facelift procedures. Using special retractors made for working under narrow skin tunnels, the trachea can be shaved down with a scalpel.
The submental tracheal shave produces offers a ‘scarless’ method to do the procedure. While it is effective, I have found that it can be difficult to get as much reduction as that which can be done through a direct skin incisional approach. This is particularly so if a rotary burring technique may be needed for maximal reduction as the narrow skin tunnel limits instrument access. Thus the submental approach must be used selectively in the right tracheal shave patient.
Dr. Barry Eppley