- Vocal fold shortening and advancement of anterior commissure (APSAAC)
Features
- Both side of the vocal folds are deepithelialized to the desired length.
Surgical tips
- Mark the vocal folds to the desired length, then deepithelialize.
- Deepithelialize completely to the anterior commisure and subglottic portion.
- Suture the vocalis muscle to the maximum amount including the subglottic portion.
Male to Female Voice Phonoplasty is a procedure that changes the voice of a male into a female voice in order to help establish the sexual identity.
Females usually differ greatly from males in the fundamental frequency and resonance. The fundamental frequency of male voices typically ranges from 100-150 Hz while ranging from 170-220 Hz in females. Men produce low voices because they have bigger chambers of the throat and mouth.
Thus, by altering the larynx, pharynx, and the chambers which produce the sound, a male sounding voice can be changed to a female-sounding voice.
There are 5 major methods used for Male to Female Voice Phonoplasty.
1. Cricothyrodiopexy: Cricothyroidiopexy was the most frequently performed surgery from 1983 and 1990. It pulls the cricoid and thyroid cartilages forward to a fixed position. It is safe because it does not have to operate the vocal folds. However, it is not being used a lot in US for it needs to incise the neck and does not bring long-term satisfaction.
2. Laser assisted thyro-arytenoid muscle resection: Proposed by the French otolaryngologist Dr. Jean Avitol in 1995, the laser assisted thyroarytenoid muscle resection uses a laryngoscope to expose the vocal folds, and reduce the size of the thyroarytenoid, and raise the voice frequency by increasing the tension of the operated area. The advantages are that it is done through endoscope and does not leave a scar in the neck. However, it has limitations in raising the pitch of a very high-pitched voice.
3. Laser assisted voice adjustment (LAVA): Dr. Lisa Orloff of the University of California introduced this surgical method of vaporizing only the mucous membrane of the vocal folds that cause the biggest waves using a laser under endoscope. Thus, it strengthens the mucosal wave the vaporized membranes produce a scar while recovering, and increases the tension of the vocal folds. The advantages are that it is done through endoscope and does not leave a scar in the neck. Its disadvantages are that it requires a long period for recovery and there are limitations in the increase of voice frequency.
4. Anterior Web Creation: It is a method that raises the voice frequency by shortening the front vibrating part of the vocal folds. Dr. Gross has reported in 1999 that the fundamental frequency of a female had increased up to 201 Hz, and there was an average increase of 81Hz. It can be done under endoscope without incising the neck, and it has brought very satisfactory results in long-term observations. However, it is not available for every patient.
5. Thyroid cartilage and vocal fold reduction: Proposed in 2000, this method incises the anterior part of the thyroid cartilage and reduces the vocal folds. It is available for males with severely thick voices and big thyroid cartilages, and it is very effective in getting high-pitches. However, if the vocal folds are excessively incised, it is difficult for the voice to recover.
As you can see above, various methods can be used as transsexual phonoplasty. However, you need to first check the larynx, the vocal folds, the vocal membrane wave and the movement of the vocal folds through laryngeal stroboscopy. After a general voice check-up, it is important to predict the best voice condition and select the appropriate surgical method.
It is very dangerous to perform just one surgery without checking your voice condition. A previous check-up must be done to predict the maximum voice condition you will be able to produce and perform the most adequate method.
The voice quality is determined by the larynx, the condition of the vocal folds, the chambers of the throat and mouth, and the lips. The vocal folds, larynx, and the chambers of the throat play the most important role in creating the voice quality and timbre.
Transsexual women have the structures and the chamber of a man, and if their fundamental frequency has been altered through vocal fold surgery, the voice becomes neuter as it passes through the chamber. However, the timbre (the resonance) can be modified through vocal treatments and voice rehabilitation by altering as the features of the chamber are self-changeable. When performed with the change in fundamental frequency, it is possible to produce a low female voice.
The voice feminization therapy must be provided by skilled professionals at a place where vocal treatments are available. You cannot expect good results at a place with no experiment in voice surgery and no availability of medical treatments. Therefore, voice feminization therapy must be provided by an experienced voice specialist under an accurate diagnosis.
Written by Yeson Voice Center
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