Comparison of Transoral and Transcutaneous Approaches for Gender-Affirming Thyroid Cartilage Reduction: A Case Series of 246 Patients.

Abstract

Thyroid cartilage reduction (TCR) for gender-affirming neck surgery can reduce prominent thyroid notches and improve dysphoria. TCR can be performed with a transoral or transcutaneous approach. This study aims to review TCR approaches and outcomes. A retrospective chart review of all TCRs at a multi-institutional, integrated health care system from May of 2016 to July of 2024 was performed. Patient demographics, operative details, and postoperative complications were reviewed. Major complications included invasive interventions (eg, corticosteroid injections for scars, fluid drainage) or intraoperative complications. Minor complications included infections, hypertrophic scarring, and temporary voice changes. Chi-square tests and Mann-Whitney U tests were performed to evaluate differences in postoperative outcomes by surgical approach. A total of 246 patients underwent TCR, with 207 patients (84.1%) in the transcutaneous group and 39 patients (15.9%) in the transoral group. The median patient age was 30.7 years (interquartile range, 24.9 to 39.0 years). Median body mass index was 22.7 kg/m 2 (interquartile range, 20.6 to 25.5 kg/m 2 ). There were no significant differences between transcutaneous and transoral groups for median age (30.1 years versus 33.4 years; P = 0.08) or median body mass index (22.6 kg/m 2 versus 23.7 kg/m 2 ; P = 0.28). Total major complication rate was 9.3% and minor complication rate was 10.6%. There were no significant differences between transcutaneous and transoral groups in rates of major (9.2% versus 10.3%; P = 0.83) or minor (12.1% versus 2.6%, P = 0.08) complications. TCR can be an effective treatment for neck dysphoria. The transoral approach avoids visible neck scars and is not associated with increased perioperative complications. Further research is needed to determine the long-term outcomes of TCR. Therapeutic, III.