Potential Tracheal Shave Complications
A tracheal shave, also known as chondrolaryngoplasty or Adam’s apple reduction, is a surgical procedure that many people consider as part of their gender-affirming journey or for aesthetic reasons. While generally safe when performed by experienced surgeons, like any surgical procedure, it comes with potential risks and complications. This comprehensive guide will help you understand what to expect and what complications may arise from tracheal shave surgery.
What is a Tracheal Shave?
A tracheal shave is a surgical procedure that reduces the prominence of the thyroid cartilage, commonly known as the Adam’s apple. During the surgery, a small horizontal incision is made in a natural crease of the neck, through which the surgeon carefully shaves down the protruding cartilage to create a smoother neck contour.
The procedure typically takes 30-60 minutes and is often performed under general anesthesia, though local anesthesia may be used in some cases. The surgeon must carefully balance the desire for reduction with maintaining the structural integrity of the larynx, making this a delicate procedure that requires significant expertise.
Understanding the Adam’s Apple
The Adam’s apple is actually the forward projection of the thyroid cartilage, which forms part of the larynx (voice box). During puberty, this cartilage tends to enlarge more significantly in people with testosterone-dominant hormone profiles, resulting in the characteristic neck prominence. The thyroid cartilage plays a crucial role in protecting the vocal cords and supporting voice production.
To learn more about the intricacies of the larynx, read our blog, “What is an Adam’s Apple?“
Tracheal Shave Complications That Can Occur
Bleeding and Hematoma Formation
One of the most immediate potential complications following a tracheal shave is bleeding. It is rare to have bleeding after a tracheal shave, but minor oozing can happen. If significant bleeding occurs, blood can accumulate beneath the skin forming a hematoma. This manifests as a firm, painful swelling that may cause discomfort or pressure symptoms.
If a hematoma develops, it can potentially compress the airway, leading to breathing difficulties. Large hematomas may require surgical drainage, while smaller ones might resolve with conservative management. Dr. Saxon will typically monitor closely for signs of hematoma formation during the first 24-48 hours after surgery.
You may be at a higher risk of hematoma if you have a bleeding disorder or have high blood pressure that isn’t controlled with medications.
Infection
Post-operative infections, while relatively uncommon, can develop and complicate the healing process. Initial signs of infection often begin with subtle changes: the surgical site may become increasingly tender, with progressive redness extending beyond the immediate incision area. You might notice increased warmth around the surgical site or experience an elevated temperature.
More serious infections can progress to involve deeper tissues, potentially forming an abscess or affecting the cartilage itself. This can lead to chondritis, an inflammation of the cartilage that may compromise the structural integrity of the larynx. There are no reported cases of this occurring after a tracheal shave.
Treatment typically involves a course of antibiotics, specifically chosen to target the most common organisms found in head and neck infections. In severe cases, surgical drainage may be necessary to remove infected tissue and promote healing.
Scarring Complications
The aesthetic outcome of a tracheal shave largely depends on the healing of the surgical incision. While Dr. Saxon typically places the incision in a natural neck crease to minimize visible scarring, the healing process can be unpredictable. Some patients may develop hypertrophic scars, which appear as raised, red tissue confined to the original incision site. If exposed to UV light, scars can develop hyperpigmentation and remain pink.
Various treatments exist for problematic scarring, including silicone gel or sheets, steroid injections, and laser resurfacing.
Voice Changes
Voice alterations following tracheal shave surgery represent a significant concern for many. The intricate relationship between the thyroid cartilage and the vocal apparatus means that even minor changes to the laryngeal framework can affect voice production. Initial changes often include temporary hoarseness or voice fatigue, which typically resolves as swelling subsides.
Some patients report subtle changes in their singing voice or ability to sustain notes, even when speaking voice remains unchanged. This is mostly due to temporary tightness of the muscles around the voicebox from swelling. It typically is short-lived and feels more normal after about 6 months.
More permanent voice changes can occur if the surgery affects the attachment point of the vocal cords called the anterior commissure. Dr. Saxon uses a flexible camera, called a laryngoscope, to look at the vocal cords during surgery to ensure that the anterior commissure is not damaged.
Laryngeal Fracture
Among the most serious potential complications is laryngeal fracture, which can occur if the structural integrity of the thyroid cartilage is compromised during surgery. This complication is rare, and only one case report is in the literature. If this happens, it requires immediate attention by placing titanium plates to repair the cartilage.
The risk of laryngeal fracture increases if the laryngeal cartilage has ossified so that it is more like bone. This can be very brittle and lead to fractures with manupulation.
Continued Prominence of the Adam’s Apple
Sometimes, despite surgery, patients may notice persistent prominence of their Adam’s apple. The vocal cords can attach to the cartilage higher than normal. If this is the case, even if all the cartilage above the level of the vocal cords is removed, there will still be some degree of prominence of the Adam’s apple. This occurs in about 20% of patients.
Additionally, swelling during the healing process can temporarily mask the final result, leading to uncertainty about the outcome for several weeks or months post-surgery.
Recovery and Long-term Outcomes
The recovery process following a tracheal shave procedure typically spans several months, during which the final results gradually become apparent. The immediate postoperative period involves managing swelling and discomfort, with most patients returning to light activities within a week.
Over the first month, swelling continues to subside, and the incision begins to mature. Patients typically see progressive improvement in any early voice changes, though the timeline varies individually. The final aesthetic outcome becomes more apparent as swelling resolves completely, usually by three to six months post-surgery.
Are You Ready for a Tracheal Shave?
While tracheal shave complications can occur, being well informed about potential risks and choosing an experienced surgeon, like Dr. Saxon, can significantly improve your outcomes. Understanding what to expect during recovery and knowing when to seek medical attention are crucial aspects of ensuring a safe and successful procedure.
Always discuss your specific concerns with Dr. Saxon and ensure you have a clear understanding of both the potential benefits and risks before proceeding with surgery. Remember that each person’s experience is unique, and while complications are possible, most patients achieve their desired results without significant issues.
Dr. Sarah Saxon is an expert in tracheal shave surgery and performs the procedure to maximize your result while remaining safe. Schedule a consultation with Dr. Saxon to see if you are a good candidate for this life-changing procedure!
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