[Application and efficacy of microscopic vocal cord shortening with retrodisplacement of anterior commissure in voice feminization surgery].

Objective: To explore the the application and outcomes of microscopic vocal cord shortening with retrodisplacement of anterior commissure in voice feminization surgery. Methods: We conducted a retrospective analysis of 296 patients(including 3 cases of pseudohermaphroditism and 293 transgender women)who underwent this procedure at the Voice Center of Nanjing Tongren Hospital of Otolaryngology-Head and Neck Surgery between November 2014 and August 2023. The patients, aged 18-50 years (mean age of 28.3±14.5) underwent feminizing laryngoplasty via transoral microsurgery, involving resection of the superficial lamina propria of the anterior vocal cords and subglottic tissues of the anterior commissure, followed by vocal ligament plication to achieve vocal cords shortening and anterior commissure retrodisplacement. Patients adhered to a1-month voice rest postoperatively and subsequently underwent speech rehabilitation training. Subjective/objective voice analyses, aerodynamic evaluations, and stroboscopic examinations were performed at 3, 6, and 12 months postoperatively to assess the effectiveness of voice feminization. Results: All surgeries were performed successfully and 94.3% (279/296) of the patients reported satisfaction at the end of the one-year follow-up. For effective cases, fundamental frequency (F0) increased by 57.42±16.72 Hz compared to baseline. Postoperative acoustic/aerodynamic parameters and stroboscopic findings of vocal cord mucosal wave motion remained within normal ranges. These results indicated that this voice feminization surgery combined with postoperative pronunciation training achieved natural and feminine vocal characteristics. Conclusion: The combination of vocal cord shortening and anterior commissure retrodisplacement, along with postoperative pronunciation training, represents an effective surgical strategy for achieving a natural feminine voice.