Wendler glottoplasty: an effective pitch raising surgery in male-to-female transsexuals.

OBJECTIVES: Evaluation of the voice results after Wendler glottoplasty in male-to-female transsexuals (MFTs). STUDY DESIGN: Retrospective case series. METHODS: We retrospectively reviewed 31 MFT patients treated with a Wendler glottoplasty technique. The procedure consists of the CO2-laser de-epithelialization of the anterior commissure along with the anterior third of the two vocal folds, the suturing of the two vocal folds with two 3.0 resorbable threads, and next, the application of fibrin sealant to strengthen the stitches. Voice assessment was based mainly on fundamental frequency, frequency range, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP), grade of dysphonia (G), and voice handicap index. The measurements were performed preoperatively and on the last follow-up visit and compared using IBM SPSS 20 statistical package (IBM Corp, Armonk, NY). The patients have been divided in two groups (group A younger than 40 years and group B of or older than 40 years) for assessing the influence of the age of treatment on the results. RESULTS: Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction. CONCLUSION: Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals.

Medialization thyroplasty for voice restoration after transoral cordectomy.

Fourteen dysphonic patients who had previously undergone total or extended cordectomy underwent medialization thyroplasty. A minimum delay of 6 months was respected to allow the spontaneous "neocord" formation, to evaluate the voice recovery achieved by speech therapy alone and to avoid an undiagnosed early recurrence. Surgery was performed under general anaesthesia, using a laryngeal mask, because undermining the fibrous tissue at the inner side of the thyroid ala is a prolonged and difficult procedure. This step was essential to ensure an easy placement of the implant and to avoid tearing the fibrous tissue, with subsequent risk of implant extrusion. Visual control of the implant implementation was obtained by flexible videoendoscopy. The Montgomery(®) implant system (Boston, Westborough, MA) was used for the majority of the cases. Hand-made modified Montgomery implants or Gore-tex(®) were used in case of extended scarring or peculiar anatomic defect. The voice assessment showed a decrease of the VHI score from 50.5 to 39.4; a decrease of G from 2.4 to 2; an increase of maximum phonation time (MPT) from 6.2 to 7.3 s; a decrease of the maximum fundamental frequency (Fo-high) from 338.7 to 242.4 Hz and a decrease of the phonation quotient from 1,144.9 to 544.9 ml/s. The lower intensity (I-low) remained unchanged, from 60 to 58 dB. Statistically significant improvement was noted only for VHI and G grading. A decrease of the voice efforts and fatigue were noticed by all the patients.