Jan. 20, 2011 — -- Thanks to a rare and difficult transplant surgery, the once voiceless Brenda Jensen has been given a new larynx, a new voice and a new lease on life.
When an accident with a ventilation tube left Jensen's vocal chords paralyzed 12 years ago, she thought she never would be able to speak again on her own.
With the aid of a mechanical larynx that she would hold to her throat, she could communicate. But the voice was robotic and her paralyzed voice box necessitated that she keep a permanent breathing tube in her throat that prevented her from ever going underwater or even taking a shower.
"The surgery had a lot of risk," she said. "I could have lost feeling in my face, movement in my eyes. I could have been not able to eat or swallow again. But I wanted to talk again and get the [tube] out of my neck."
After the 18-hour operation in October that replaced her larynx, trachea, and thyroid gland, Jensen said she now is "talking up a storm" and looking forward to the last stage in the process when the tube in her throat can be removed.
The procedure, which was done at the UC Davis Medical Center in California, is one of the most complex transplantations because surgeons must reconnect not only blood vessels but microscopic nerves needed for the coordinated movements of breathing, swallowing and speaking.
Now, three months later, Jensen said her "voice improves every day."
"It's been a long road and a rough road, but every minute of it was worth it," she said. "Now when I talk, my friends who know me from way back say they can hear me in there. I heard myself on a recording the other day and I was amazed."
"We are absolutely delighted with the results of this extraordinary case," Dr. Gregory Farwell, lead surgeon for the transplant, said in a press release.
Jensen, who is also a kidney-pancreas transplant recipient, is the second patient to ever receive a larynx transplant. The first was performed at the Cleveland Clinic in 1998 on Tim Heidler, then 40.
The procedure is so rare not only because of the difficulty involved, but because it requires the patient to be on a lifetime of immuno-suppressing drugs to prevent the rejection of the donor tissue. Because Jensen is already on these meds for her donor kidney and pancreas, she was a uniquely apt candidate.
New Windpipe, New Voice Box, New Voice
Heidler had been without a voice for 20 years when he approached the doctors at the Cleveland Clinic. A motorcycle accident had crushed his larynx and pharynx, leaving him completely unable to speak and robbing him of his sense of smell and taste.
"Tim found us," said the lead surgeon on the procedure, Dr. Marshall Strome, director of the Center for Head and Neck Oncology at St. Luke's Roosevelt Hospital in New York. "A good decade of research and testing the procedure on animal models came before we would attempt it. But it had never been done before in a human. There has to be a leap of faith because you just don't know. Tim is the brave one."
Heidler recovered his voice, which he says now sounds a bit like his father's voice, and 13 years later "continues well today," Strome said.
"Rejection and infection are the major things you worry about," says Heidler, "but it was 13 years since my surgery January 4th and I'm doing real good."
Despite the success of Heidler's procedure, no other larynx transplant was attempted in the U.S. until Jensen's.
Part of the reason was a decrease in the number of patients in need of the procedure, Strome said.
Years ago, the most common reason for an injured larynx was automobile accidents because the throat would slam into the steering wheel upon impact. Thanks to airbags, which protect against such an injury, and better techniques for fixing or reconstructing injured larynxes, there are not as many patients who would qualify for a transplant.
Even those who may benefit from a transplant must be able to live with the necessary immuno-suppressing medications for the rest of their life. That takes those with laryngeal cancer, who otherwise would be prime candidates for transplant, out of the running because the drugs could increase the chance of their cancers returning, Strome said.
Cancer Patients Prime Candidates in Future
With the help of knowledge gained from Heidler and Jensen's surgeries, doctors are working towards a more workable way to transplant part or all of a larynx in cancer patients.
"When you give immunosuppresion so that the organ won't reject, you're giving the cancer a better chance to come back and grow," said Strome. "But we've learned a ton in terms of making a transplant potentially doable even ... in the face of cancer."
Thanks to better techniques for removing larynx cancers and the success of chemoradiation, a larynx transplant would only be needed for a minority of laryngeal cancer patients, so it's likely to remain a rare procedure.