Sequential Wendler Glottoplasty and Laser Reduction Glottoplasty for Voice Feminization

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Abstract
Objective: Voice feminizing surgery is frequently needed for transgender female patients. Among several surgical options, Wendler glottoplasty (WG) and laser reduction glottoplasty (LRG) are two endoscopic procedures. However, because a single procedure may not produce sufficient benefit, the two surgeries may sometimes be sequentially performed. This study was carried out to present the voice results of such sequential surgeries.Methods: This is an individual retrospective cohort study, performed at a tertiary referral center, that is a university hospital. 18 transgender patients were treated with WG initially and then underwent LRG; 17 had LRG first then WG. All 35 cases were performed during a 15-year period and followed for at least 1 year postoperatively. Voice Handicap Index (VHI-30), transsexual voice questionnaire (TVQ), and acoustic analysis with /a/ and running speech were obtained pre- and postoperatively.Results: VHI and TVQ improved significantly postoperatively (p < 0.05). Their preoperative, first, and second postoperative mean sF0 were 146, 175, and 215 Hz, respectively; these differences were statistically significant (p < 0.001). Their postoperative mean jitter percent, shimmer percent, noise to harmonic ratio (NHR), cepstral peak prominence (CPP), and cepstral spectral index of dysphonia (CSID) worsened significantly compared to preop values (p < 0.05); however, mean postoperative acoustic results were still within normal limits. Patients' self-ratings of their postsurgery voices revealed all feminine, leading to a patient gratification score of 100%.Conclusion: If transgender female patients are unsatisfied with their voice after WG or LRG, the addition of the alternative procedure may significantly feminize their voice. Sequential WG and LRG is a successful surgical option for voice feminization.Level of Evidence4 Laryngoscope, 2023

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