The reduction of a prominent Adam’s Apple is known as a tracheal shave. Done directly over the tracheal prominence through a small skin incision the V-shaped thyroid cartilage is reduced, as the name indicates, by shaving it down with a scalpel blade. Since the prominence is composed of cartilage it can be reduced in layers with the sharp edge of a blade. As patients age the thyroid cartilage becomes stiffer and more calcified and may have to be burred down for an effective reduction.
While the skin incision for a tracheal shave is small and often heals exceedingly well, the risk of a visible scar always exists. While the procedure will always require a skin incision, an alternative location would be higher in the submental region under the chin. This distant incision location requires the creation of a subcutaneous tunnel down the midline from the chin to the thyroid prominence. Using a fiberoptic retractor the prominent cartilage can be seen and dissected free of overlying tissues.
Because the thyroid cartilage is a mobile structure, trying to shave it down with a scalpel blade from a remote incision is difficult. For this reason I prefer to use a handpiece and drill and burr the cartilage prominence down. This works just as well on soft cartilage as it does on harder cartilage. A small round or tapered carbide burr removes cartilage structure rapidly. Within the tight space of this subcutaneous tunnel it is important to be careful with a rapidly rotating burr to not inadvertently engage the surrounding soft tissues.
Because of the more limited visibility from this remote incision, a submental reduction should not be used when larger tracheal shaves are needed. Better control of the shape of thyroid prominence can be obtained by a direct incisional approach.
Dr. Barry Eppley