A Massachusetts man has regained his voice after a team of surgeons removed his larynx due to cancer and, in a groundbreaking procedure, replaced it with a donated voice.
Laryngeal transplants are extremely rare and are not usually an option for people with active cancerMarty Kedian is only the third person in the United States to undergo a total laryngeal transplant. The other two transplants were performed years ago on patients with injuries, and are among a small number of such transplants performed worldwide.
Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial aimed at offering the operation to more patients, including some with cancer — the most common way to lose a larynx.
“People need to save their voice,” said Kedian, 59, four months after his transplant, still hoarse but able to hold an hour-long conversation. “I want people to know that this can be done.”
He became emotional as he recalled the first time he called his 82-year-old mother after the operation “and she could hear me… That was important to me, to talk to my mother.”
The study is small — only nine more people will be enrolled. But through this study, scientists can learn about best practices for these complex transplants so they can one day be offered to more people who can’t breathe, swallow or speak for themselves because of a damaged or surgically removed larynx.
“Patients become recluses and isolate themselves from the rest of the world,” said Dr. David Lott, a chair of head and neck surgery at Mayo Clinic in Phoenix. “My patients tell me, ‘Yeah, I may be alive, but I’m not really alive,’” Lott said, explaining why he started the study.
Lott’s team reported preliminary results of the surgery in the journal Mayo Clinic Proceedings.
The larynx is the instrument with which humans generate voice, but it is also vital for breathing and swallowing. Pieces of muscle tissue called vocal cords open to allow air into the lungs, close to prevent food or drink from being diverted, and vibrate when air pushes past them to produce speech.
The first two patients who underwent a transplant laryngeal surgeons in the United States—one at the Cleveland Clinic in 1998 and another at the University of California, Davis, in 2010—had lost their voices due to injuries, one following a motorcycle accident and the other after being damaged by a hospital respirator.
But cancer is the main reason. The American Cancer Society estimates that more than 12,600 people will be diagnosed with cancer by 2024. with some type of cancer larynx. Although many people now undergo voice-preserving treatments, thousands of people have had their larynx completely removed, breathe through a so-called tracheostomy tube in their neck, and have difficulty communicating.
Although early laryngeal transplant recipients in the United States were able to speak almost normally, doctors have not favored these transplants. That’s partly because people can survive without a larynx, while anti-rejection drugs (which they must take after surgery) suppress the immune system, potentially triggering new or recurring tumors.
“We want to push those boundaries, but do so in the safest and most ethical way possible,” Lott said.
Head and neck specialists say the Mayo Clinic trial is key to helping laryngeal transplants become a viable option.
It’s not an “isolated case” but a chance to finally learn from one patient before operating on the next, said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.
This first attempt at a cancer patient “It is the next important step,” he said.
Other options are being studied, said Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant. His patients at high risk for larynx loss record their voices in anticipation of next-generation speech devices that sound like them.
However, Belafsky claims that “There are still possibilities” laryngeal transplants become more widespread, while cautioning that more years of research are likely needed. One hurdle has been getting the nerves to grow back enough to breathe without an endotracheal tube.
Kedian was diagnosed with a rare cancer of the laryngeal cartilage a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen operations and ended up needing an endotracheal tube to breathe and swallow. He was forced to retire on disability.
However, the once sociable Kedian, known for his long conversations with strangers, did not allow doctors to remove his entire larynx. to cure cancerHe desperately wanted to read stories to his granddaughter in his own voice, instead of using what he called robotic devices.
Then Kedian’s wife, Gina, found the Mayo Clinic study. Lott decided he was a good candidate because his cancer was not fast-growing and, especially important, Kedian was already taking anti-rejection drugs from a previous kidney transplant.
It took 10 months to find a deceased donor with a larynx that was healthy enough and of the right size.
On February 29, six surgeons operated on him for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donated larynx and the necessary adjacent tissues. —thyroid and parathyroid glands, pharynx and upper part of the trachea—as well as the tiny blood vessels that supplied them. Finally, using new microsurgical techniques, they connected essential nerves that allowed Kedian to sense when to swallow and move his vocal cords.
About three weeks later, Kedian said “hello”. He soon relearned how to swallow, moving from applesauce to macaroni and cheese and hamburgers. He was able to say hello to his granddaughter Charlotte via video, as part of his homework to continue speaking.
“Every day it’s getting better,” said Kedian, who will soon return to Massachusetts. Her tracheostomy will remain in place for at least a few more months, but “I’m trying hard to move forward faster because I want to get these tubes out, get back to a normal life.”
And just as Lott had assured him, Kedian kept his beloved Boston accent.
:
