Resorbable material for osteosynthesis or titanium for the cricothyroidopexy?

Background: The failure of cricothyroid approximation in male-to-female-transsexuals - as described by Isshiki - is often caused by suture cutting through the cartilage early postoperatively. At this stage there is no stabilized scarring and the previously approximated edges of the cartilage can drift apart, lowering the voice pitch through reduction of the tension of the vocal cords. The cartilage can be protected from cutting injuries of the wire sutures by using mini plates made of either titanium or Lacto-Sorb(R). The present study examined the influence of the different materials on the result. Patients and Methods: A cricothyroidopexy in male-to-female-transsexuals was performed in 67 patients between October 1993 and December 2001. The medium age was 39 years, ranging from 24 to 67 years. For stabilizing the thyroid and cricoid cartilage titanium mini plates were used in 28 patients (41,8%) and Lacto-Sorb(R) mini plates in 39 (58,2%). A complete voice diagnostic work-up was performed pre- and postoperatively. Results and Conclusions: In 94% of all patients the medium speaking voice could be raised on average by five half tones through the increased tension of the vocal cords. In 39% very good (rise by more than 12 half tones) and good (rise by six to 12 half tones) results could be achieved, while in 55% a minimal (one to two half tones) or very small (three to five half tones) rise was noted. The material of the mini plates had no impact on the degree of voice pitch raising, the long-term results or the number of revision surgeries.