What is Adam’s apple
Adam’s apple is the common term used to describe what is officially named the laryngeal prominence of the thyroid cartilage (see Figure 2). The thyroid cartilage is the largest of nine cartilages in the larynx. The laryngeal prominence, the Adam’s Apple specifically, is the most visible portion of this structure on the exterior and is where the two halves of cartilage meet. Another name for the larynx is the voice box, and it’s in your throat. The larynx is what gives you your voice, whether you’re talking, laughing, whispering, singing, or shouting. You can find your larynx by touching the front of your throat and humming. When you feel vibrations under your fingers, you’ve found it.
Adam’s apple is one of the most significant external landmarks in the neck and is very useful for anatomical orientation in procedures, most notably in identifying the cricothyroid membrane for a cricothyroidotomy. Adam’s apple is notably more prominent in men than women and primarily acts to protect the vocal cords behind it. Additionally, as the Adam’s apple is a secondary sex characteristic, its appearance is a cosmetic consideration in the transsexual community and those exploring gender affirmation/ reassignment surgery 1.
When kids hit puberty, their bodies and minds go through tons of changes. One change that every kid can count on is lots of body parts growing and changing shape. Almost every part gets in on the growing action, including the larynx.
When the larynx grows larger during puberty, it sticks out at the front of the throat. This is what’s called an Adam’s apple. Everyone’s larynx grows during puberty, but a girl’s larynx doesn’t grow as much as a boy’s does. That’s why boys have Adam’s apples. Most girls don’t have Adam’s apples, but some do. It’s no big deal either way.
This larger larynx also gives boys deeper voices. Actually, girls’ voices get a little bit deeper as their larynxes get larger, too. But because boys’ larynxes grow so much more, it makes their voices deeper than girls’ voices.
Adam’s apple (the thyroid cartilage) has important historical, cultural, and interventional implications. Adam’s apple (the thyroid cartilage) is a secondary sexual characteristic: meaning it appears around the time of puberty and helps distinguish between the sexes, as it is more prominent in men than it is in women. The swelling of the laryngeal prominence takes place during puberty and is logically thought to play a role in the voice mutation that also occurs in this period. However, no work has yet been done to prove this relationship decisively, only small reports of cadaver studies 2.
The classic measurement of the interlaminar angle at the level of the vocal processes is 90 degrees in the male population, and 120 in females 1. The broader angle in women causes it to protrudes less, not push up against the skin of the neck, and ultimately be less visible. In both sexes, regardless of the angle, the primary function of the Adam’s Apple is the same as that of the thyroid cartilage which it comprises, to protect the vocal cords immediately behind it.
Figure 1. Larynx and pharynx anatomy
Figure 2. Larynx anatomy
Do girls have Adam’s apple?
Yes, but a girl’s larynx doesn’t grow as much as a boy’s does. That’s why boys have Adam’s apples. Most girls don’t have Adam’s apples, but some do. It’s no big deal either way.
Why is it called Adam’s apple?
The colloquial name Adam’s apple is thought to come from the story of the Garden of Eden where Adam ate a piece of the forbidden fruit that got stuck in his throat or just a mistranslation of the Hebrew term for the structure that is described as “the swelling of a man” (Haubrich) 1. An Adam’s apple sometimes looks like a small, rounded apple just under the skin in the front of the throat.
Adam’s apple removal
Chondrolaryngoplasty, also known as trachea or “trach” shave, is a purely cosmetic outpatient procedure done to reduce the girth of the Adam’s apple. It has an excellent prognosis and is generally performed by plastic surgeons for patients who have undergone gender affirmation surgery or no longer desire to have a visible Adam’s apple 1. In patients post-gender affirmation surgery, it is often performed in conjunction with a crico-thyroidopexy procedure that aims to raise the pitch of the patient’s voice 3.
The ala, or laminae, of the thyroid cartilage, also have some use as the source for a graft in various cases. It has been used in laryngotracheoplasty to repair pediatric tracheocutaneous fistulas 4. A recent case report showed a patient with posterior glottic stenosis effectively treated with a posterior cricoid split and thyroid ala cartilage graft 5.
References- Fitzpatrick TH, Siccardi MA. Anatomy, Head and Neck, Adam’s Apple. [Updated 2018 Dec 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535354
- Glikson E, Sagiv D, Eyal A, Wolf M, Primov-Fever A. The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation. Laryngoscope. 2017 Oct;127(10):E354-E358.
- Kreukels BPC, Köhler B, Nordenström A, Roehle R, Thyen U, Bouvattier C, de Vries ALC, Cohen-Kettenis PT., dsd-LIFE group. Gender Dysphoria and Gender Change in Disorders of Sex Development/Intersex Conditions: Results From the dsd-LIFE Study. J Sex Med. 2018 May;15(5):777-785
- Cheng J, Jacobs I. Thyroid ala cartilage graft laryngotracheoplasty for closure of large pediatric tracheocutaneous fistula. Int. J. Pediatr. Otorhinolaryngol. 2013 Jan;77(1):147-9.
- Gaffey MM, Sun RW, Richter GT. A novel surgical treatment for posterior glottic stenosis using thyroid ala cartilage – A case report and literature review. Int. J. Pediatr. Otorhinolaryngol. 2018 Nov;114:129-133
