开放性女性化喉成形术，环甲酰胺指标（CTA），IV型甲状腺成形术。

         声音女性化手术的目的是提高男女跨性别患者声道的基本频率和共振频率。音调，声音和语音之间存在一些差异。 声带就像发声器，各个音高取决于声带振动的频率。 我们的喉咙，嘴巴，鼻子和鼻窦的大小和形状使声音有所不同。 嘴唇，牙齿和舌头的运动将语音转换为我们称为语音的单词和句子。语音受大脑控制，以表达感觉，思想，情感等。因此，语音练习对于成功进行语音外科手术和 说话舒服。 这就是为什么只能由经验丰富的跨性别语音言语治疗师来教言语练习的原因。

手术前

              在手术前至少2周停止吸烟。 在进行任何甲状腺手术之前，需要对每位患者进行仔细的视频喉镜检查和频谱声学研究，以更好地计划手术并评估手术后的结果。 考试持续一小时，包括程序讨论，替代治疗，风险，问题和答案。 进行第一次评估后，患者将每周花费一小时，每周2-3次，与言语治疗师一起将声音重新训练成自然语言。

图片1 甲状旁腺	图片2 人声道

图片3 声带显示

手术方法

              该手术的目的是通过外科手术使甲状腺软骨更靠近环状软骨，缝合方式不可吸收，使声带不被触摸而是被动地伸展。该程序通过用缝合线刺激环甲亢的肌肉收缩而增加了声带。它增加了声带褶t之间的距离并增加了声带的张力。环形和甲状腺软骨尽可能地接近，因为术后不可避免地要转向低位。声音的基本频率上升到可感知地与生物学女性的声音重叠。该手术在全身麻醉下进行。持续时间大约为40-50分钟，可以同时进行亚当苹果的手术切除。通常，患者不会感到任何术后疼痛，但是如果完成亚当的苹果手术，则可能会出现疼痛。在任何情况下，疼痛都是轻度的，并且可以用止痛药完全控制。

              在可能出现的皮肤皱纹中形成横向切口疤痕，如果可能的话，在喉咙上甲状腺软骨的椎中点水平进行，这是一个约2厘米的小手术开口，几乎看不见疤痕

图4声带显示前后对比

优点

-此过程不会干扰声带或在声带上造成疤痕，而会导致永久性的声音嘶哑
-如果患者不满意，理论上是可逆的
-可以同时进行外科手术减少喉结

缺点

-需要颈部切口
-长期结果不一致

手术后护理

-第1到7天：绝对安静，直到第一次随访。没有饮食限制。
-第3至7天：通过喝足够的水滋润声带，并用无菌盐溶液雾化。
-第8天到第10天：在声音休息期之后，进行了新的电视喉镜检查和频谱声学研究，去除了外缝线，进行了敷料并开始了语言疗法的康复。

言语治疗师将教患者如何以最佳方式使用她的新声音。最终结果将在手术后的第三个月至第八个月之间看到。因此，建议在手术后的第三，第六，第十二个月进行随访。

注意: 如果即将来临的患者已经使用另一种技术进行了变声手术并且对他/她的声音结果不满意，则外科团队保留根据具体情况评估可行性的权利。

为了防止酸倒流，强烈建议避免使用咖啡因，巧克力，薄荷，脂肪性食物，酸性食物，苏打水和酒精饮料。

工作和活动：只要可以遵守语音限制，就可以放假一周。如果需要使用语音，则需要放假两周。

Female to male voice surgery or voice masculinization:

              This type of surgery is performed if the patient is not satisfied with his voice despite the use of the male hormone therapy that, unlike the female one, lower the fundamental frequency of the voice.

Before the surgery, an accurate videolaringostroboscopic and spectrum-acoustic study of the voice is performed to highlight its real fundamental frequency and to plan the best operation in line with the patient needs.

              In this case the surgical intervention consists of an increase in the mass of the vocal cards through an intra-cords injection of biocompatible material (from autologous fat to hydroxyl-apatite depending on the cases).To the increase vocal cords mass, follows a lowering of the voice fundamental frequency, as desired by patient. The operation is performed under general anesthesia and its duration is about 20- 30 minutes. The patient generally does not experience any pain after surgery and feeding has no limitations.

              After the surgery there is a mandatory period of silence of about two days. A new videolaringostroboscopic and spectrum-acoustic study is then performed to evaluate the new fundamental frequency and afterwards the patient can start talking again, always with the help of speech therapist.

              As usual, only one injection of biocompatibility material is sufficient, but the biological re-absorption of the injected material is individual and not predictable in each case. Regularly the male voice duration long lasts some years and in any case this operation is perfectly repeatable.

Voice Feminization Surgery (MTF Voice Surgery) in Bangkok, Thailand

Having a natural sounding feminine voice is important to complete the male-to-female sex reassignment surgery. After voice feminizing surgery, our speech therapists, Ms. Srinakorn Prohmtong and Ms. Sirirat Prayoonperaput, guide you to your new voice that will define your identity.

Ms. Srinakorn Prohmtong	Ms. Sirirat Prayoonperaputcan
Speech and Voice Therapist	Speech and Voice Therapist

Male to female voice therapy is voice therapy to feminize the voice. Male to female voice training will help patient naturally communicate with authentic voice that is true to their gender identity. You will learn how to develop a feminine voice from the basic of frequency and tone with ease. Your posture, behavior and facial expression is important as well. The speech therapists will help you to gain control of your voice with crucial aspects such as breathing,
resonance, intonation and the combination of these aspects with natural feminine voice.

Therapy can start both before and after surgery to achieve the best result, only 10 minutes a day.

Voice feminization speech therapy

            Voice feminization speech therapy is a treatment to refine your voice, making it sound more feminine. The treatment has to be done before and after the voice feminization surgery to provide your effortless control of speech. Before voice feminization surgery is performed, your voice has to be assessed and tuned to let you have a proper speech. After voice feminization surgery is performed, you would have to learn to feminize your voice and how to speak effortlessly. This program is provided by a specialized, skilled speech therapist, inclusive of multiple sessions of practice until you complete all aspects of voice feminization therapy, under the guidance of our speech therapist. Practicing without a guidance of the specialist may result in edema of your vocal cord and can cause a failure in our training program.

Voice feminization training program @ Kamol Cosmetic Hospital

            Before having a voice feminization surgery, your voice and speech would be assessed by our speech therapist, preferably about one week prior to the surgery. Our speech therapist will help you tune your voice and let you speak with the least effort as a preparation session before the surgery.

            After the voice feminization surgery, you will be appointed with the speech therapist to assess your vocal cord function and help you speak in a healthy manner. This session would be held at the second and fourth week after the surgery. You will be given daily voice exercise as homework to yield the best result. Afterwards, monthly online follow-up meetings with our speech therapist can be arranged via Skype. This way, you can get your voice analysis at home or wherever most convenient to you. Each meeting should be around one hour.