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Background:  The youthful neck in a male has few surface landmarks to make it distinguishable. Men will almost always have some laryngeal prominence which is gender specific as most females do not. This laryngeal  prominence is known as the Adam’s apple and it occurs in men because the hormonal influences make the angle of the thyroid cartilages become bigger as they grow around the trachea.

The purpose of the thyroid cartilages is to protect the larynx which includes the vocal cords which are located directly behind it. As the male thyroid cartilage gets bigger with the larynx the voicebox correspondingly gets bigger as well and accounts for the deeper voice in men with a larger soundboard. (bigger phonation apparatus)

Reduction of the prominent thyroid cartilage is surgically known as a chondrolaryngoplasty and has its most common association with transgender facial feminization surgery where a smooth neck profile is the goal. (180 degree laryngeal angle)But in my experience about half of the patients I see for a ‘tracheal shave’ are non-transgender men. They simply have an excessive laryngeal prominence which is disproportionate to their often slimmer neck which has little subcutaneous fat. This tends itself to a ‘laryngeal reveal’.

Case Study: This young male was bothered by the large size of his ‘Adam’s apple’. He was taller and slender and had a thin neck. His laryngeal prominence was considerable. Even though there are no mathematical formulas or ratios to determine the optimal amount of projection of the male larynx, it is fair to say that when the laryngeal angle becomes less obtuse than 120 to 130 degrees, most would interpret it as being too prominent.

Under general anesthesia, a 3 cm skin incision was made directly over the laryngeal prominence in a faint skin crease. The angle of the thyroid cartilages were reduced to a near flat or 180 degrees. Reapproxination of the strap muscles provided a buffering of the cartilage edges.

The change in neck profile was significant and the ultimate scarring from the incision negligible.

Highlights:

1) While tracheal reduction is most commonly associated with transgender facial feminization surgery, it is equally applied to the make with a strong tracheal prominence. (big Adam’s apple)

2) The direct incisional approach provides the greatest amount of tracheal reduction in the most controlled and safest manner.

3) The direct neck incision heals well when placed in a horizontal skin crease.

Dr. Barry Eppley

Indianapolis, Indiana

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