The prominent lump in the neck, commonly known as the Adam’s apple, is a visible feature that can be surgically altered. This procedure, formally termed chondrolaryngoplasty, reduces the size and projection of this anatomical structure. The operation is often called a tracheal shave, although the trachea itself is not the target of the surgery. Individuals pursue this modification for cosmetic reasons or as part of gender affirmation surgery to achieve a smoother neck contour.
Understanding the Laryngeal Cartilage
The Adam’s apple is the colloquial name for the laryngeal prominence, the most forward-projecting part of the thyroid cartilage. This cartilage is the largest of the nine cartilages forming the larynx, or voice box. Its primary purpose is to shield the delicate vocal cords and the airway from external damage. While the structure exists in all people, its size and visibility differ significantly between the sexes.
During puberty, increased testosterone causes the thyroid cartilage to enlarge. The angle where the two halves meet becomes sharper, typically around 90 degrees in males, creating the pronounced bump visible on the throat. In females, the angle remains wider, closer to 120 degrees, resulting in a smaller or less visible prominence. Since the thyroid cartilage supports the vocal apparatus, the procedure is one of reduction, removing only the excess projection rather than the total structure.
Surgical Technique for Reduction
Chondrolaryngoplasty requires precise surgical technique to safely reduce the cartilage prominence without compromising the voice. The surgery is typically performed under general anesthesia, though local anesthesia with sedation is sometimes used. It generally takes between 30 minutes and two hours to complete. The surgeon begins by making a small incision, often placed transversely in a natural skin crease of the neck or beneath the chin to minimize the visible scar.
After the incision, the surgeon carefully dissects through the subcutaneous tissue to expose the thyroid cartilage. Identifying the precise location of the vocal cords, which attach to the inner surface of the cartilage at the anterior commissure, is a crucial step. Modern techniques often use a flexible fiberoptic endoscope, inserted through the mouth or nose, to visualize the vocal cords from the inside. This allows the surgeon to accurately mark the superior limit of the vocal cord attachment.
A needle may be inserted through the cartilage to confirm this safe boundary, ensuring the reduction does not interfere with the vocal mechanism. The surgeon then uses a scalpel or a high-speed burr to carefully shave down the prominent portion of the thyroid cartilage. The goal is to smooth the anterior contour while leaving enough cartilage to maintain the structural integrity of the larynx and prevent damage to the vocal cords. After contouring, the muscles and soft tissues are repositioned, and the incision is closed with fine sutures in multiple layers to minimize scarring.
Post-Operative Care and Associated Risks
Following the tracheal shave, patients can expect a recovery period involving managing discomfort and monitoring the surgical site. Immediately after the procedure, the neck area will be swollen and bruised. Patients may experience soreness or a feeling similar to a mild sore throat, particularly when swallowing. Pain is managed with prescription medication for the first few days, followed by over-the-counter pain relievers.
Initial recovery is relatively quick, with most swelling resolving within the first two weeks, allowing many patients to return to work and light activities. However, the final aesthetic outcome requires more time, as residual swelling can take two to three months to fully subside. The scar will continue to mature and fade over six to nine months.
While the procedure is generally safe, specific risks exist due to the delicate anatomy of the neck. Scarring is a common concern; although the incision is often placed strategically, there is a risk of a raised or hypertrophic scar forming. A more serious, though rare, risk is voice alteration, which can manifest as temporary hoarseness or, in rare cases of overly aggressive reduction, a permanent change in pitch or vocal quality. Other potential complications include infection, bleeding leading to a hematoma, and insufficient cartilage reduction requiring a revision procedure.