Comparison of Transoral and Transcutaneous Approaches for Gender-Affirming Thyroid Cartilage Reduction: A Case Series of 246 Patients

Background: Thyroid cartilage reduction (TCR) for gender-affirming neck surgery can reduce prominent thyroid notches and improve dysphoria. TCR can be performed with a transoral or transcutaneous approach. This study aims to review TCR approaches and outcomes. Methods: A retrospective chart review of all TCRs at a multi-institutional, integrated healthcare system from May 2016 to July 2024 was performed. Patient demographics, operative details, and post-operative complications were reviewed. Major complications included invasive interventions (corticosteroid injections for scars, fluid drainage, etc) or intraoperative complications. Minor complications included infections, hypertrophic scarring, and temporary voice changes. Chi square tests and Mann-Whitney U tests were performed to evaluate differences in postoperative outcomes by surgical approach. Results: A total of 246 patients underwent TCR with 207 patients (84.1%) in the transcutaneous group and 39 patients (15.9%) in the transoral group. The median patient age was 30.7 years (interquartile range, IQR 24.9-39.0). Median BMI was 22.7 kg/m 2 (IQR 20.6-25.5). There were no significant differences between transcutaneous and transoral groups, for median age (30.1 years vs 33.4 years, p= 0.08) or median BMI (22.6 kg/m 2 vs 23.7 kg/m 2 , p= 0.28). Total major complication was 9.3% and minor complication was 10.6%. There were no significant differences between transcutaneous and transoral groups in rates of major (9.2% vs 10.3%, p= 0.83) or minor (12.1% vs 2.6%, p= 0.08) complications. Conclusion: TCR can be an effective treatment for neck dysphoria. Transoral approach avoids visible neck scars and is not associated with increased peri-operative complications. Further research is needed to determine the long-term outcomes of TCR.