Feb 25, 2014 8:00 AM

Authors: P. Daniel Ward, MD , Jaron McMullin, MD

You may have heard the recent news about former Olympic gold medalist and reality TV star Bruce Jenner having his laryngeal cartilage or Adam’s apple reduced. There’s been a lot of speculation about the Keeping Up With The Kardashians star, because this procedure is one of many often performed as part of male to female gender reassignment surgery. While Jenner hasn’t reveled his motivations for the surgery, it has fueled interest in the topic.

What is laryngeal cartilage reduction surgery and why is it part of the male to female transition? The answer to that question is in the anatomy of the neck.

The front of the neck has two main structures that can usually be felt. From top to bottom, these structures are the laryngeal cartilage (or Adam’s apple) and the cricoid cartilage. In men, the most prominent firm structure you are likely to see or feel is the Adam’s apple, whereas in women, the cricoid cartilage tends to be the structure that is more easily felt and seen. The Adam’s apple is located higher up in the neck and is more sharply defined. The cricoid cartilage is lower in the neck and is a broader and flatter structure.

The thyroid cartilage or Adam’s apple is just one of a number of facial features that we recognize as male or female. The male face and head is usually larger and more angulated than females. Females usually have thinner brows that sit just above the bony rim above the eyes. In addition, the female nose and chin are usually more rounded and less angular than males.

The reason male to female gender reassignment patients seek to have the thyroid cartilage or Adam’s apple trimmed down is to make the anterior neck appear more feminine. A large Adam’s apple, a hump on the nose, or a heavy low-set brow are all features that tend to make one look more masculine.

The procedure itself involves an incision in the neck to access the cartilage, which is then reduced. It is a procedure that is generally quite safe. However, it is adjacent to some very important structures--the airway and the vocal folds. Although the risk is very low, each of these structures can be damaged with the procedure, which should only be performed by a surgeon with extensive experience working in the area.

Regardless of a person’s motivations for having it, thyroid cartilage reduction is likely to become a more popular surgery due to this new spotlight on the procedure.

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