{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:28:59Z","timestamp":1789000139424,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T00:00:00Z","timestamp":1598313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Anterior (Wendler) glottoplasty has become a popular surgery for voice feminization. However, there has been some discrepancy between its theoretical pitch\u2010raising potential and what is actually achievable, and downsides to shortening the glottis have not been fully explored. In addition, descriptions of the surgery are inconsistent in their treatment of the vocal ligament. This study aimed to determine 1) how fundamental frequency (<jats:styled-content><jats:italic>f<\/jats:italic><jats:sub><jats:italic>o<\/jats:italic><\/jats:sub><\/jats:styled-content>) is expected to vary with length of anterior glottic fixation, 2) the impact of glottic shortening on sound pressure level (SPL), and 3) the effect of including the ligament in fixation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Computational simulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Voice production was simulated in a fiber\u2010gel finite element computational model using canonical male vocal fold geometry incorporating a three\u2010layer vocal fold composition (superficial lamina propria, vocal ligament, and thyroarytenoid muscle). Progressive anterior glottic fixation (0, 1\/8, 2\/8, 3\/8, etc. up to 7\/8 of membranous vocal fold length) was simulated. Outcome measures were <jats:styled-content><jats:italic>f<\/jats:italic><jats:sub><jats:italic>o<\/jats:italic><\/jats:sub><\/jats:styled-content>, SPL, and glottal flow waveforms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content><jats:italic>f<\/jats:italic><jats:sub><jats:italic>o<\/jats:italic><\/jats:sub><\/jats:styled-content> increased from 110\u2009Hz to 164\u2009Hz when the anterior one\u2010half vocal fold was fixed and continued to progressively rise with further fixation. SPL progressively decreased beyond 1\/8 to 1\/4 fixation. Inclusion of the vocal ligament in fixation did not further increase <jats:styled-content><jats:italic>f<\/jats:italic><jats:sub><jats:italic>o<\/jats:italic><\/jats:sub><\/jats:styled-content>. Any fixation increased aperiodicity in the acoustic signal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The optimal length of fixation is a compromise between pitch elevation and reduction in output acoustic power. The simulation also provided a potential explanation for vocal roughness that is sometimes noted after anterior glottoplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA <jats:italic>Laryngoscope<\/jats:italic>, 131:1081\u20131087, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28940","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T19:02:51Z","timestamp":1598382171000},"page":"1081-1087","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Vocal Tradeoffs in Anterior Glottoplasty for Voice Feminization"],"prefix":"10.1002","volume":"131","author":[{"given":"Ingo R.","family":"Titze","sequence":"first","affiliation":[{"name":"National Center for Voice and Speech University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Palaparthi","sequence":"additional","affiliation":[{"name":"National Center for Voice and Speech University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1804-6707","authenticated-orcid":false,"given":"Ted","family":"Mau","sequence":"additional","affiliation":[{"name":"Clinical Center for Voice Care, Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Southwestern Medical Center  Dallas Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,25]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"335","article-title":"Surgical alteration of the vocal pitch","volume":"12","author":"Isshiki N","year":"1983","journal-title":"J Otolaryngol"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948309200513"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948509400604"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2890040512"},{"key":"e_1_2_6_6_1","unstructured":"WendlerJ.Vocal pitch elevation after transexualism male to female. 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