Unusual transplant restores woman's voice
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In one of the most complex transplant operations ever performed, an international team of surgeons, including Paolo Macchiarini from Karolinska Institutet in Stockholm, has restored the voice of a Californian woman who had been unable to speak for more than a decade.
The surgical team announced today at a press conference that they had replaced the larynx (voicebox), thyroid gland and trachea (windpipe) of a 52-year-old woman who had lost her ability to speak and breathe on her own. The 18-hour operation, which took place over a two-day period in October 2010, is only the second documented case of its kind in the world. Just 13 days after the operation, the patient voiced her first words in 11 years and is now able to speak easily and at length.
Today the patient, Brenda Charett Jensen, is meeting her entire surgical team in California for the first time since the transplant.
"The larynx is an incredibly complex organ, with intricate nerves and muscles functioning to provide voice and allow breathing," says Gregory Farwell, associate professor of otolaryngology at UC Davis Health System and lead surgeon for the transplant. "Our success required that we assemble an exceptional, multi-disciplinary team, use the most recent advances in surgical and rehabilitation techniques, and find a patient who would relish the daunting challenges of undergoing the transplant and the work necessary to use her new voicebox."
Prior to the transplant, Ms Jensen was unable to speak or breathe normally because of complications stemming from a previous operation several years ago that closed off her airway and made her completely dependent on a tracheotomy tube. For more than a decade, she has been limited to vocalising words using a handheld electronic device that produces an artificial, robot-like sound. In order to breathe, she has relied on the tracheotomy, which is still in place and visible at the base of her neck.
Farwell led a surgical team that included Peter Belafsky, associate professor of otolaryngology at UC Davis Medical Centre, Martin Birchall, professor of laryngology at the University College London Ear Institute in the UK, Paolo Macchiarini, visiting professor of regenerative surgery at Karolinska Institutet and Quang Luu, assistant professor of otolaryngology at UC Davis Health System.
Currently, transplantation is not an option for everyone who suffers from a missing or non-functioning larynx because it requires a lifelong regimen of immunosuppressant medication to guard against organ rejection. Immunosuppressant therapy is associated with numerous medical complications and a greater chance of developing certain cancers over the lifetime of a transplant. As a kidney-pancreas transplant recipient four years ago and already taking anti-rejection medication, Ms Jensen was a unique candidate for the procedure.
Macchiarini, whose primary research interest involves transplantation of airways and tissue-engineered airway replacements, also views Jensen´s transplantation as transformative.
"Being able to restore nerves and reconnect blood vessels in and around the larynx and trachea, and have it all work, was a real test," says Macchiarini, who led the world´s first in-human transplantation of a tissue-engineered windpipe in 2008. "Not only is it highly relevant for future transplants, it offers us insights that may one day lead to using stem cells to repair the voicebox and surrounding areas in the throat."
Ms Brenda Jensen is following a rigorous regimen of daily swallowing exercises, which have helped restore sensation in her throat. Before being allowed to eat or drink, Ms Jensen must be tested by her doctors to ensure that she can safely swallow. If all goes well, Ms Brenda Jensen hopes to have her tracheotomy tube removed in the coming months, which would allow her to resume a completely normal life.
"Every day is a new beginning for me," says Ms Jensen. "I´m working so hard to use my vocal cords and train my muscles to swallow. I´ll probably never sing in a choir or anything, but it´s exciting to talk normally, and I can´t wait to eat and drink and swim again!"