History in the Making
A recent groundbreaking surgical procedure performed at the UC Davis Medical Center has given a patient the gift of speech, an ability that she had lost for over eleven years due to laryngeal and tracheal damage. 52-year-old Brenda Jensen repeatedly pulled at a breathing tube inserted down her throat while under sedation during hospitalization for kidney failure in 1999. This caused severe and irreplaceable damage to her larynx, which houses the vocal cords. The trachea, which functions as the windpipe, was also damaged. She not only lost her ability to speak, but also her ability to eat and her senses of smell and taste.
The 18-hour surgery involved transplantation of an entirely new organ through means of microsurgical techniques. This procedure is extremely rare; in fact, this is only the second documented laryngeal transplantation case in the world. The surgery was led by Dr. Gregory Farwell, an associate professor of otolaryngology at the UC Davis Medical School. Dr. Farwell explained that although this procedure is rare, he sees cases of laryngeal and tracheal damage on a regular basis. “In my practice, I often see severe problems of the larynx associated with cancer and disease. Irreparable damage to the larynx is fairly common,” he said.
Dr. Farwell also explained that in preparation for the surgery, it was necessary to find a perfect donor match. In any transplantation surgery, donor compatibility ensures that the recipient body does not reject the new organ as a foreign object. In addition to this, the patient must be placed on lifelong immunosuppressants, which inhibit activity of the immune system in order to prevent rejection from occurring in the future. Brenda had already been placed on lifelong immunosuppressant therapy following her kidney transplantation surgery.
The actual procedure itself required a medical team of over two-dozen people, five of which were primary surgeons. Integrating the new organ into Brenda’s body required re-connecting all of the surrounding nerves and blood vessels. “First, the team tested the donor organ using a saline solution to ensure that the larynx was healthy and would permit good blood flow,” said Dr. Farwell. “[Transplanting the organ] required reconnecting five nerves, two arteries and three veins.” An animation demonstrating this delicate procedure can be seen here: http://webcast.ucdavis.edu/flashv2/?file=Burnett/7210/Transplant.flv
The surgery took place this past October, and Brenda is already on her way to a full recovery. She is able to speak again with a voice that, according to her family and friends, is similar to her original voice. Her voice may continue to change as her muscles develop and grow stronger. Her senses of taste and smell have also been partially restored and will continue to develop as she heals. She cannot eat food or drink liquids yet because the mechanisms for safely swallowing are not yet fully functional. Through daily physical therapy exercises, these functions will be restored eventually and she will hopefully be able to live a fully normal life.
This groundbreaking procedure has made a huge contribution to the field of otolaryngology and to the world of medicine. “We now know more about the structure and function of the larynx and trachea, and how those organs respond and recover from surgical procedures,” explained Dr. Farwell. He also mentioned that his colleagues in Europe are interested in using knowledge from this surgery to implement stem cell therapy as a tissue regeneration method for patients with damage to the laryngeal tracheal section of the throat.
Unfortunately, this will never be a common surgery due to the fact that it is not a life-saving procedure. A larynx is not necessary for survival. It has, however, given Brenda a quality of life that she thought she had lost forever. “Every day is a new beginning for me,” she said at a press conference. “I’m working so hard to use my vocal chords 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!”