Please make sure your trach shave surgeon can clearly explain how they will determine the exact location of the vocal cord attachment to the trachea cartilage (scientific name is thyroid cartilage). The cartilage and prominence can only be removed above that. If they cannot explain that then I would run. If you shave at or below the attachment, you will detach the vocal cords and cause permanent hoarseness and breathing issues. The method we use is after making a small less than 1cm under the chin (not over the cartilage!), We then expose the entire thyroid cartilage and the laryngeal prominence which is responsible for the visible adams apple. The anesthesiologist uses a laryngeal mask airway (LMA) to provide general anesthesia and a fiberoptic bronchoscope is passed through the LMA into the throat and the vocal cords are seen. Then through the neck, a small needle is pierced through the thyroid cartlage and with the flexible bronchoscope, we can determine the exact location of the vocal cord attachment. The area is marked on the thyroid cartilage and all the cartilage above that can be removed. Without this technique, its all guesswork and significant risk of causing permanent voice problems after. Also using this technique, all the cartilage can be maximally shaved to the limits of safety and to not cause complications after.
