Hybrid external-endoscopic wendler glottoplasty: achieving scarless anterior synechia in the challenging larynx

Anterior commissure exposure is the primary challenge in Wendler glottoplasty, often hindering successful suturing in narrow or prominent larynges.

We describe a “scarless” hybrid technique for difficult cases. Following fiber-laser de-epithelialization, two 18-gauge trocars are inserted percutaneously through the thyroid cartilage. A suture is passed through the trocars, retrieved endoscopically, and tied externally over a Silastic sheet, bypassing endolaryngeal space constraints. Hyaluronic acid is injected to reduce suture tension.

This combined approach salvages the procedure when endoscopic exposure is inadequate, ensuring a tight synechia without visible cervical scarring, optimizing outcomes for transgender patients.