Case 74 (2008) 30 yo FemLar procedure complicated by infection

This 30 yo had been living as a female for many years. She had a trach shave 8 years ago without complications. She passes for female on the phone about 70% of the time, but when fatigued or if she speaks loudly her voice becomes more masculine.

She had a complication after the FemLar TH procedure of an infection. The plate was removed by another surgeon. Her voice was terrible (diplophonic at 8 months recording below). She returned to me at 8 months and we removed some infected sutures to clear up the infection. And because one cord was looser than the other we tightened up that cord with a laser. Her voice improved a great deal 6 weeks later (10 month recording).

These recordings are set to a fairly low resolution for the internet but do demonstrate the general sound and function of the vocal cords before and after this case of laryngeal reduction surgery. Much more detail is actually visible in the office. The videos when shown are oriented with the front down and the left vocal fold is on the right of the video. Orientation is discussed here. Please note: These examples of possible results should not be construed to represent what will be acheived in any other patient. Thus there are several examples of patients on the site

There are many components to a voice exam. I have selected ones here that I feel change the most with this type of surgery.

 

Pre Surgery

8 months

10 months

6 weeks post laser voice tuning

 

Reading passage

Pitch is described relative to C4 or middle C on the piano.

  

Pitch: about D3 - mid-male range

(typical male speaking range about B2 - E3)

Pitch: very diplophonic (A3/D4)

(normal female speaking range about E3 - A3)

Pitch: about A3#

(normal female speaking range about E3 - A3)

 

Lowest pitch

  

Pitch: about G2 (normal male low range varies C1 - C3)

Pitch: about A3 (normal female low range varies between B2 - F3)

Pitch: about A3#

  

Highest pitch

  

Pitch: about B4

Pitch: about F4#

Pitch: about B4

  

Vegetative sounds

coughing & throat clearing

  

 

diplophonic

 

  

Yell

loud phonation

  

 

 

 

  

Laryngoscopy

Views

        
vocal cords
 vocal cords
vocal cords
  

Stroboscopy

saying the sound /i/

        
vocal cords
vocal cords
vocal cords
  
Neck front view:

Neck front view

Neck front view

Neck front view
Neck profile view:

Neck profile view

Neck profile view

Neck front view
The surgeon’s comments:

I removed about 40% of her anterior vocal cords. She developed an infection of her neck that never really cleared up while she lived far away. Another surgeon removed the plate that I had placed to tighten the cords as it was no longer needed, but the infection persisted. When she returned to me at 8 months, I removed 3 infected sutures. We also used the office laser to selectively tighten the looser of the two vocal cords. When two cords are have a different tension, they vibrate at different pitches and that was the reason for her double pitched voice on the 8 month recording. She returned at 10 months for a scar revision. Her voice was much improved and she is perceived as a female 100% of the time on the phone.

In the neck photos, she had already had a trach shave, yet there was still some protrusion. Of course the infection has given her a poor scar at the 8 month setting and it was still adherent at 10 months and has been revised, hopefully with some photos to follow when it heals. (written 5/22/09).