Abstract
In our department, a thyro-arytenoid muscle myectomy (TA myectomy) and a type 2 thyroplasty (TP2) are performed for adductor spasmodic dysphonia (SD). The operative method is chosen depending on the case. Here, we report the surgical treatment in an SD patient with gender identity disorder (GID). The case was a 32-year-old female. She had GID associated with underlying disease, and she underwent sex re-assignment surgery in March 2005. Her family register entry was changed afterwards from a man to a woman. For sometime, she was upset by her low-pitched speaking fundamental frequency (SFF). Then several years ago, her voice became spasmodic and she came to our department on August 7, 2007. According to the mora method, her voice was assessed as follows : 11/21, SFF : 133.3 Hz, lowest pitch : 124.2 Hz, highest pitch : 418.2 Hz, MPT : 21 s. The patient was hoping for improvement of her spasmodic voice and a rise in her SFF. With a TA myectomy, both effects can be expected. We usually choose TA myectomy first, and in the event of an unsatisfactory result we add a type 4 thyroplasty (TP4) as a 2nd stage operation. TA myectomy was performed on the current patient on October 4, 2007. After six months, her voice according to the mora method was as follows : 0/21, SFF : 200.1 Hz, lowest-pitch : 151.1 Hz, highest-pitch : 364.1 Hz, MPT : 12 s. She hoped to raise the SFF slightly more, so a TP4 was added and scheduled for May 27, 2008. One month after the TP4, her voice by the mora method was as follows : 0/21, SFF : 244.8 Hz, lowest-pitch : 213.0 Hz, highest-pitch : 322.4 Hz, MPT : 8 s. We performed a second operation for an SD patient who had GID. For SD, TA myectomy was effective, but for the GID-associated low-pitched voice, TA myectomy was not effective. A TP4 was therefore added, and excellent results were obtained. The combination of TA myectomy and a TP4 was effective in the present case.
