Feminization Laryngoplasty (continued)
Thyrohyoid elevation: Muscles are elevated from the anterior inferior half of the hyoid bone with electrocautery. Strap muscles are divided at their insertion along the inferior edge of the hyoid bone for 15 mm either side of midline.
Drilling holes for closure: Two, 1-mm holes are drilled in the new anterior edge of each thyroid cartilage, one inferior at the level of the subglottis, one superior at the level of the false vocal cords. Each hole is angled toward the midline internally. To create the thyrohyoid elevation, two additional holes are placed along each superior border of the thyroid cartilage where the upper wings were removed. The softer the cartilage, the further from the upper cut edge of thyroid cartilage I place these holes to avoid tear-out later when tightening. Four holes are drilled into the hyoid bone, two either side of midline. These are angled slightly inferiorly to allow passage of the large needle on 0-Ethibond sutures.
Four braided, 0-Ethibond sutures are individually passed through each hole in the superior edge of the thyroid cartilage and passed through a corresponding hole in the hyoid bone. No sutures are tied yet.