Adam's apple

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Adam's apple
Structure of Adam's apple.png
Front view of the Adam's apple (laryngeal prominence)
Details
Precursor Fourth and sixth pharyngeal arches
Identifiers
Latin prominentia laryngea
TA98 A06.2.02.003
TA2 968
FMA 55304
Anatomical terminology

The Adam's apple is the protrusion in the neck formed by the angle of the thyroid cartilage surrounding the larynx, typically visible in men, less frequently in women. The prominence of the Adam's apple increases in some men as a secondary male sex characteristic during puberty. [1]

Contents

Structure

The topographic structure which is externally visible and colloquially called the "Adam's apple" is caused by an anatomical structure of the thyroid cartilage called the laryngeal prominence or laryngeal protuberance protruding and forming a "bump" under the skin at the front of the throat. All human beings with a normal anatomy have a laryngeal protuberance of the thyroid cartilage. This prominence is typically larger and more externally noticeable in adult males. There are two reasons for this phenomenon. Firstly, the structural size of the thyroid cartilage in males tends to increase during puberty, [2] and the laryngeal protuberance becomes more anteriorly focused. Secondly, the larynx, which the thyroid cartilage partially envelops, increases in size in male subjects during adolescence, moving the thyroid cartilage and its laryngeal protuberance towards the front of the neck. The adolescent development of both the larynx and the thyroid cartilage in males occurs as a result of hormonal changes, especially the normal increase in testosterone production in adolescent males. In females, the laryngeal protuberance sits on the upper edge of the thyroid cartilage, and the larynx tends to be smaller in size, and so the "bump" caused by protrusion of the laryngeal protuberance is much less visible or not discernible. [3] Even so, many women display an externally visible protrusion of the thyroid cartilage, an "Adam's apple", to varying degrees which are usually minor, and this should not normally be viewed as a medical disorder.

Function

The Adam's apple, in relation with the thyroid cartilage which forms it, helps protect the walls and the frontal part of the larynx, including the vocal cords (which are located directly behind it). [4]

Another function of the Adam's apple is related to the deepening of the voice. During adolescence, the thyroid cartilage grows together with the larynx. Consequently, the laryngeal prominence grows in size mainly in men. Together, a larger soundboard is made up in phonation apparatus and, as a result, men get a deeper voice note. [5] [6]

Society and culture

A diagram demonstrating a general outline of the feminization laryngoplasty (FemLar) surgical technique using a top-down horizontal cross section of the larynx. The area labeled "front" in each image is the Adam's Apple/Laryngeal Prominence. In a tracheal shave, superficial tissue at the front of the larynx is dissected and the general shape of the larynx's interior, along with the underlying vocal cords, are otherwise unaffected. In feminization laryngoplasty, the Adam's Apple is moved back even further by modifying the underlying vocal cords as well, and the voice and interior of the larynx are also affected. Cross section of thyroid cartilage before and after laryngoplasty at 9.11.34 PM.png
A diagram demonstrating a general outline of the feminization laryngoplasty (FemLar) surgical technique using a top-down horizontal cross section of the larynx. The area labeled "front" in each image is the Adam's Apple/Laryngeal Prominence. In a tracheal shave, superficial tissue at the front of the larynx is dissected and the general shape of the larynx's interior, along with the underlying vocal cords, are otherwise unaffected. In feminization laryngoplasty, the Adam's Apple is moved back even further by modifying the underlying vocal cords as well, and the voice and interior of the larynx are also affected.

While both men and women can possess an Adam's apple, the larger frequency of its appearance in men has led to the perception of the Adam's apple as an indicator of masculinity. As such, transgender women may choose to undergo cosmetic surgery to remove it from their necks, a process known as chondrolaryngoplasty, or colloquially as a "tracheal shave". [7] Transgender men may choose to augment and thereby enlarge the Adam's apple, a process known as masculinization. [8]

Chondrolaryngoplasty surgery is effective, and studies done by surgeons in Tel Aviv and Los Angeles have demonstrated complications to be few and, if present, transient. [9] [10] [7]

There is also an additional surgery available, feminization laryngoplasty, also known as "FemLar", which can safely reduce the Adam’s Apple to an extent greater than that which can be accomplished by a tracheal shave, given it explicitly operates on the vocal cords within the Adam’s Apple as opposed to avoiding them. However, feminization laryngoplasty is a reconstructive surgery that carries additional risks and has a very strong feminizing effect on the voice that may or may not be desirable to the patient. [11] [12] [13] There are also far fewer practitioners who are known to be currently performing FemLar as it is far newer than the tracheal shave procedure.

Etymology

An example of male laryngeal prominence (front view) Adam's apple 26.jpg
An example of male laryngeal prominence (front view)
An example of male laryngeal prominence (side view) Adam's apple 10.jpg
An example of male laryngeal prominence (side view)
An example of female laryngeal prominence (front view) Woman's Adam Apple.jpg
An example of female laryngeal prominence (front view)
An example of female laryngeal prominence (side view) Female adams apple.png
An example of female laryngeal prominence (side view)

The English term "Adam's apple" is a calque of Latin pomum Adami, which is found in European medical texts from as early as 1600. [14] "Adam's Apple" is found in a 1662 English translation of Thomas Bartholin's 1651 work Anatomia. [15]

The 1662 citation includes an explanation for the origin of the phrase: a piece of forbidden fruit was supposedly embedded in the throat of Adam, who according to the Abrahamic religions was the first man: [15]

the common people have a belief, that by the judgment of God, a part of that fatal Apple, abode sticking in Adams Throat, and is so communicated to his posterity

This etymology is also proposed by Brewer's Dictionary of Phrase and Fable and the 1913 edition of Webster's Dictionary. [16] The story is not found in the Bible or other Judeo-Christian or Islamic writings. [17]

Linguist Alexander Gode proposed in 1968 that the Latin phrase pomum Adami (literally: 'Adam's apple') was a mistranslation of the Hebrew "tappuach ha adam meaning 'male bump'". [18] The confusion was supposedly due to the fact that in the Hebrew language the proper name "Adam" (אדם) literally means "man", and the word for "apple", "tapuach", is similar to the word "tafuach" which means "swollen", thus in combination: the swelling of a man. [19] [20]

The medical term "prominentia laryngea" (laryngeal prominence) was introduced by the Basle Nomina Anatomica in 1895. [21]

In the American South, "goozle" is used colloquially to describe the laryngeal prominence, likely derived from guzzle . [22] [23] [24] [25]

Laryngeal prominence anatomy

See also

Related Research Articles

<span class="mw-page-title-main">Vocal cords</span> Folds of throat tissues that help to create sounds through vocalization

In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through vocalization. The size of vocal cords affects the pitch of voice. Open when breathing and vibrating for speech or singing, the folds are controlled via the recurrent laryngeal branch of the vagus nerve. They are composed of twin infoldings of mucous membrane stretched horizontally, from back to front, across the larynx. They vibrate, modulating the flow of air being expelled from the lungs during phonation.

<span class="mw-page-title-main">Larynx</span> Voice box, an organ in the neck of amphibians, reptiles, and mammals

The larynx, commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about 4–5 centimeters in diameter. The larynx houses the vocal cords, and manipulates pitch and volume, which is essential for phonation. It is situated just below where the tract of the pharynx splits into the trachea and the esophagus. The word 'larynx' comes from the Ancient Greek word lárunx ʻlarynx, gullet, throatʼ.

<span class="mw-page-title-main">Trachea</span> Cartilaginous tube that connects the pharynx and larynx to the lungs

The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals with lungs. The trachea extends from the larynx and branches into the two primary bronchi. At the top of the trachea, the cricoid cartilage attaches it to the larynx. The trachea is formed by a number of horseshoe-shaped rings, joined together vertically by overlying ligaments, and by the trachealis muscle at their ends. The epiglottis closes the opening to the larynx during swallowing.

Chondroplasty is surgery of the cartilage, the most common being corrective surgery of the cartilage of the knee.

<span class="mw-page-title-main">Recurrent laryngeal nerve</span> Nerve in the human body

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and left. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under the right subclavian artery then traveling upwards. They both travel alongside the trachea. Additionally, the nerves are among the few nerves that follow a recurrent course, moving in the opposite direction to the nerve they branch from, a fact from which they gain their name.

<span class="mw-page-title-main">Posterior cricoarytenoid muscle</span> Muscle of the larynx

The posterior cricoarytenoid muscle is a intrinsic muscle of the larynx. It arises from the cricoid cartilage; it inserts onto the arytenoid cartilage of the same side. It is innervated by the recurrent laryngeal nerve. Each acts to open the vocal folds by pulling the vocal fold of the same side laterally. It participates in the production of sounds.

<span class="mw-page-title-main">Cricoid cartilage</span> Complete ring of cartilage around the trachea

The cricoid cartilage, or simply cricoid or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment site for muscles, cartilages, and ligaments involved in opening and closing the airway and in producing speech.

Chondrolaryngoplasty is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat, generally to aid those who are uncomfortable with the girth of their Adam's apple.

<span class="mw-page-title-main">Thyroid cartilage</span> Largest of nine cartilages that make up the laryngeal skeleton

The thyroid cartilage is the largest of the nine cartilages that make up the laryngeal skeleton, the cartilage structure in and around the trachea that contains the larynx. It does not completely encircle the larynx.

<span class="mw-page-title-main">Cricothyroid muscle</span> Muscle of the larynx

The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve. Its action tilts the thyroid forward to help tense the vocal cords, thus increasing the pitch of the voice.

<span class="mw-page-title-main">Arytenoid cartilage</span> Part of the larynx, to which the vocal folds (vocal cords) are attached

The arytenoid cartilages are a pair of small three-sided pyramids which form part of the larynx. They are the site of attachment of the vocal cords. Each is pyramidal or ladle-shaped and has three surfaces, a base, and an apex. The arytenoid cartilages allow for movement of the vocal cords by articulating with the cricoid cartilage. They may be affected by arthritis, dislocations, or sclerosis.

<span class="mw-page-title-main">Arytenoid muscle</span> Muscle of the larynx

The arytenoid muscle or interarytenoid muscle is a composite intrinsic muscle of the larynx, consisting of a transverse part and an oblique part - the two parts may be considered as separate muscles: an unpaired transverse arytenoid muscle, and a bilaterally paired oblique arytenoid muscle.

<span class="mw-page-title-main">Lateral thyrohyoid ligament</span>

The lateral thyrohyoid ligament is a round elastic cord, which forms the posterior border of the thyrohyoid membrane and passes between the tip of the superior cornu of the thyroid cartilage and the extremity of the greater cornu of the hyoid bone. The internal branch of the superior laryngeal nerve typical lies lateral to this ligament.

<span class="mw-page-title-main">Inferior thyroid artery</span> Artery of the neck

The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle. It then turns medially behind the carotid sheath and its contents, and also behind the sympathetic trunk, the middle cervical ganglion resting upon the vessel.

<span class="mw-page-title-main">Superior laryngeal nerve</span> Branch of the vagus nerve

The superior laryngeal nerve is a branch of the vagus nerve. It arises from the middle of the inferior ganglion of vagus nerve and additionally also receives a sympathetic branch from the superior cervical ganglion.

"Voice therapy" or "voice training" refers to any non-surgical technique used to improve or modify the human voice. Because voice is a social cue to a person's sex and gender, transgender people may frequently undertake voice training or therapy as a part of gender transitioning in order to make their voices sound more typical of their gender, and therefore increase their likelihood of being perceived as that gender. Having voice and speech characteristics align with one's gender identity is often important to transgender individuals, whether their goal be feminization, neutralization or masculinization. Voice therapy can be seen as an act of gender- and identity-affirming care, in order to reduce gender dysphoria and gender incongruence, improve the self-reported wellbeing and health of transgender people, and alleviate concerns over an individual being recognized as transgender.

<span class="mw-page-title-main">Globus pharyngis</span> "Lump in the throat" sensation

Globus pharyngis, globus hystericus or globus sensation is the persistent but painless sensation of having a pill, food bolus, or some other sort of obstruction in the throat when there is none. Swallowing is typically performed normally, so it is not a true case of dysphagia, but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.

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Thyroplasty is a phonosurgical technique designed to improve the voice by altering the thyroid cartilage of the larynx, which houses the vocal cords in order to change the position or the length of the vocal cords.

<span class="mw-page-title-main">Feminization laryngoplasty</span>

Feminization laryngoplasty is a reconstructive surgery surgical procedure that results in the increase of the pitch of a patient, making the voice sound higher and more feminine. It is a form of Open Laryngoplasty and effectively reaches its goals via a Partial Laryngectomy of the anterior portion of the larynx, thereby diminishing the size of the larynx to cisgender female proportions. It also changes the vocal weight or resonance quality of the voice by diminishing the size of the larynx. It is a type of voice feminization surgery (VFS) and an alternative to vocal therapy. Feminization laryngoplasty is performed as a treatment for both transgender women and non-binary people as part of their gender transition, and women with androphonia. The surgery can be categorized into two main steps: Incision and vocal fold modification followed by thyrohyoid elevation. Risks and complications include granuloma, dysphonia and tracheostomy. Patients are recommended to follow perioperative management such as voice rest to hasten recovery.

References

  1. ↑ Fitzpatrick, Thomas H.; Siccardi, Marco A. (2022), "Anatomy, Head and Neck, Adam's Apple", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30570975 , retrieved 2023-03-19
  2. ↑ "Prominentia laryngea". Medicine Online. Archived from the original on 2013-12-25. Retrieved 2013-02-27.
  3. ↑ "Laringe". Sisbib.unmsm.edu.pe. Retrieved 2013-02-27.
  4. ↑ "Adam's Apple Reduction vs. Voice Feminization — Facialteam". 2022-04-27. Retrieved 2023-04-13.
  5. ↑ P. J. Bentley (1980), "Endocrine Pharmacology: Physiological Basis and Therapeutic Applications", CUP Archive, pág 240
  6. ↑ "Pubertad, nuestras diferencias". Esmas.com. Archived from the original on 2004-09-08. Retrieved 2013-02-27.
  7. 1 2 "UCLA surgeons develop new technique to reduce Adam's apple without neck scar". UCLA. Retrieved 2023-01-02.
  8. ↑ Deschamps-Braly, Jordan C.; Sacher, Caitlin L.; Fick, Jennifer; Ousterhout, Douglas K. (April 2017). "First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple)". Plastic and Reconstructive Surgery. 139 (4): 883e–887e. doi:10.1097/PRS.0000000000003185. ISSN   1529-4242. PMID   28350659. S2CID   25766890.
  9. ↑ Wolfort FG, Dejerine ES, Ramos DJ, Parry RG (1990). "Chondrolaryngoplasty for appearance". Plast. Reconstr. Surg. 86 (3): 464–9, discussion 470. doi:10.1097/00006534-199009000-00012. PMID   2385664.
  10. ↑ "How a New Scarless Surgery Could Affect Transgender Patients". Time. Retrieved 2023-01-02.
  11. ↑ Kim, Hyung-Tae (2020). "Vocal Feminization for Transgender Women: Current Strategies and Patient Perspectives". International Journal of General Medicine. 13. NIH: 43–52. doi: 10.2147/IJGM.S205102 . PMC   7024865 . PMID   32104050.
  12. ↑ Thomas, James Philip (2022). "Feminization Laryngoplasty - A Comprehensive Approach to Reducing the Size of the Larynx and Pharynx". Otolaryngologic Clinics of North America. 55 (4). NIH: 739–748. doi:10.1016/j.otc.2022.05.002. PMID   35750518. S2CID   249934885 . Retrieved 2 September 2023.
  13. ↑ Thomas, James Philip. "Feminization Laryngoplasty - Surgical Creation of a Feminine Voice" (PDF). VoxDoc. James Philip Thomas. Retrieved 2 September 2023.
  14. ↑ du Laurens, André (1600). Historia Anatomica Humani Corporis. Paris. p. 510. Huius supreme pars βρόγχος, quibusdam vulgò morsus & pomum Adami appelatur.
  15. 1 2 Bartholin, Thomas (1662) [1651]. Bartholinus Anatomy. Translated by Culpeper, Nicholas; Cole, Abdiah. London: Peter Cole. p. 123. That same bunch which is seen on the foreside of the Neck, is called Adams Apple, because the common people have a belief, that by the judgment of God, a part of that fatal Apple, abode sticking in Adams Throat, and is so communicated to his posterity[Protuberantia illa in collo anterius conspicua, dicitur Pomum Adami; [quia vulgo persuasum in Adami faucibus pomi fatalis partem ex pœna Divina remansisse, & ad posteros translatam]]
  16. ↑ E. Cobham Brewer (1810–1897). Dictionary of Phrase and Fable. 1898. "Adam's Apple"
  17. ↑ George Crabb (1823), "Universal technological dictionary", Baldwin, Cradock, and Joy, "Pomum Ada'mi"
  18. ↑ Gode, Alexander (1968-10-28). "Just Words". JAMA. 206 (5): 1058. doi:10.1001/jama.1968.03150050046009.
  19. ↑ William S. Haubrich (2003), "Medical Meanings: A Glossary of Word Origins", ACP Press, pág 5.
  20. ↑ "Adam's apple". Medicine.academic.ru. Retrieved 2013-02-27.
  21. ↑ Axel Karenberg, Amor, Äskulap & Co.: klassische Mythologie in der Sprache der modernen Medizin, Schattauer, Stuttgart 2006, S. 128-129.
  22. ↑ Morris, Evan (November 2008). "Goozle « The Word Detective". The Word Detective. Retrieved 22 December 2014. If we follow 'goozle' back a bit further, we come to an interesting intersection with a far more common word, 'guzzle.'
  23. ↑ Roy Blount Jr. (29 September 2009). Alphabet Juice: The Energies, Gists, and Spirits of Letters, Words, and Combinations Thereof; Their Roots, Bones, Innards, Piths, Pips, and Secret Parts, Tinctures, Tonics, and Essences; With Examples of Their Usage Foul and Savory. Farrar, Straus and Giroux. ISBN   978-1-4299-6042-7. The Dictionary of Smoky Mountain English defines google (or goozle) as 'the throat, Adam's apple.'
  24. ↑ Roy Wilder (1 September 1998). You All Spoken Here. University of Georgia Press. p. 55. ISBN   978-0-8203-2029-8. Adam's apple; goozle; the projection formed by the thyroid cartilage in the neck.
  25. ↑ "Goozle". Dictionary of American Regional English. Harvard College. Retrieved 28 November 2020. The throat as a whole, or spec the gullet, windpipe, or Adam's apple. chiefly South, South Midland
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