Impact of Infraglottic Capture in Anterior Glottoplasty Pitch Elevation in an Ex Vivo Porcine Model

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OBJECTIVE: Endoscopic vocal fold shortening (EVFS) often focuses on the anterior-posterior (AP) web dimension as a proportion of vocal fold (VF) length. We investigated the craniocaudal dimension to determine whether thick infraglottic web geometry produces greater fundamental frequency (F0) elevation than thin webs of equivalent AP dimension. METHODS: Supraglottic structures were removed from eight porcine larynges. Compressed air passed through the glottis achieved phonation under three conditions: baseline, thin web, and thick web. Thin web sutures placed at a mean of 37% of VF length captured only the superior free edge; thick web sutures placed at the same AP position captured the entire infraglottic vibratory surface. F0 was extracted from audio recordings. Wilcoxon signed-rank tests with Bonferroni correction compared F0 elevation between conditions. RESULTS: Baseline F0 was 361.5 Hz (IQR: 308.7-392.0 Hz). Thin webs elevated F0 to 535.1 Hz (Hodges-Lehmann estimated shift [HL] +162.6 Hz [95% CI: -39.3-382.5 Hz]) but with high interspecimen variability (V = 29, p = 0.445). Thick webs produced a more consistent, significant elevation from baseline F0 to 652.0 Hz (V = 36, p = 0.023; HL +255.4 Hz [95% CI: 68.1-452.9 Hz]). Thick webs produced greater F0 elevation than thin webs but did not reach significance (V = 33, p = 0.117; HL +78.9 Hz [95% CI: 1.3-282.9 Hz]). CONCLUSION: This model demonstrates that EVFS three-dimensional web geometry impacts F0 elevation not only through its AP dimension but also through incorporation of the infraglottic vibratory surface. Deliberate infraglottic capture may represent a technically modifiable variable to optimize pitch elevation in gender-affirming voice surgery. LEVEL OF EVIDENCE: NA.

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