Husain Solomon, Campe Lauren, Mirza Natasha
Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
J Voice. 2025 Jul;39(4):958-962. doi: 10.1016/j.jvoice.2023.01.028. Epub 2023 Mar 24.
Transgenderism is a condition regarding the gender identity of an individual where their psychological gender is discordant with their anatomic gender. For patients transitioning from Male to Female, voice changes are created predominantly with voice therapy, with vocal surgery as an adjunct if the patient desires it. A common surgical technique is the Wendler Glottoplasty. A CO laser is used to de-epithelialize the anterior third of the vocal folds and the anterior one-third of the folds are sutured together. This shortens the vibratory folds and increases the fundamental frequency (F) of the voice. We present a novel modification that incorporates use of injectable aqueous carboxy-methyl-cellulose gel (Prolaryn) to medialize the anterior aspect of the vocal folds and apply fibrin glue sealant (Tisseal) in lieu of sutures, simplifying the operative technique and a thyroarytenoid myectomy for debulking of the cords in select cases.
We present ten patients treated with our modified Wendler Glottoplasty technique. Voice assessment was based on F and frequency range pre and post-operatively measured via MDVP and Real-Time Pitch on the Computerized Speech Lab.
The 10 patients had an average age of 34.0 years (range 22.2-64.3 years). The average preoperative F was 136.1 Hz, with an average frequency range of 108.3-282.4 Hz. Postoperatively, the average F was 245.9 Hz, with an average frequency range of 197.3-300.7 Hz. This led to an average F increase of 106.3 Hz.
Our modification to the Wendler Glottoplasty successfully resulted in a significant increase in the postoperative F. In addition, there was improved satisfaction in vocal character after the procedure, compared to their preoperative vocal character.
性别认同障碍是一种个体的心理性别与其解剖学性别不一致的状况。对于从男性转变为女性的患者，嗓音变化主要通过嗓音治疗来实现，如果患者有需求，嗓音手术可作为辅助手段。一种常见的手术技术是温德勒声门成形术。使用二氧化碳激光去除声带前三分之一的上皮组织，并将声带的前三分之一缝合在一起。这会缩短振动的声带并提高嗓音的基频（F）。我们提出了一种新颖的改良方法，该方法采用可注射的羧甲基纤维素水凝胶（Prolaryn）使声带前部内侧化，并使用纤维蛋白胶密封剂（Tisseal）代替缝合，简化了手术技术，并且在特定情况下进行甲状杓肌切除术以减少声带体积。
我们展示了10例接受改良温德勒声门成形术治疗的患者。嗓音评估基于术前和术后通过计算机语音实验室的MDVP和实时音高测量的F和频率范围。
10例患者的平均年龄为34.0岁（范围22.2 - 64.3岁）。术前平均F为136.1Hz，平均频率范围为108.3 - 282.4Hz。术后，平均F为245.9Hz，平均频率范围为197.3 - 300.7Hz。这导致平均F增加了106.3Hz。
我们对温德勒声门成形术的改良成功地使术后F显著增加。此外，与术前嗓音特征相比，术后患者对嗓音特征的满意度有所提高。
