Staff Nurse UCLA Ronald Regan Medical Center Los Angeles, California, United States
Description: Laryngeal prominence is an area of concern for trans-female patients. Reduction of this cartilage through an anterior neck, or submental incision, is undesirable due to the noticeable scar. An endoscopic approach was developed to eliminate the need for a scar. A team of surgeons, perioperative nurses, vendors, and surgical instrumentation personnel were involved in developing this procedure. The tools were sourced that would create a space in the anterior neck for the work to take place in the absence of an expandable cavity. The cartilaginous tissue proved difficult to manipulate with traditional endoscopic instrumentation. The addition of a ronguer and small burr proved more effective. The application of these instruments allowed the procedure to evolve into a three step process. Entering through the mandibular labial mucosal, the tissue is dissected to the larnyx with a paddle electrode. The space is held open by a with a hooded endoscope sheath. A rougeur then removes pieces of the lateral cartilage. A burr completes the reduction by shaving the anterior tip of the larnyx. The outcome, with this small set of instruments, proved efficient and provides the surgeon with a way to reduce the laryngeal prominence without a scar. Perioperative nurses are in a unique position to assist in solving technical problems and help in innovation. With our ability to apply knowledge from different disciplines, we access a broader range of solutions to assist our patients.