After his malignant larynx was removed and, in a novel procedure, a donated one was implanted in its place, the man from Massachusetts was able to speak again. Voice box transplants are incredibly uncommon and typically not an option for cancer patients who are actively battling their disease. Marty Kedian is just one of the few people known to have undergone a whole larynx transplant globally and the third person in the United States to have done so (the other two had injuries years prior).
Kedian was offered the transplant by doctors at the Mayo Clinic in Arizona as part of a new clinical trial designed to make the most frequent method of larynx loss—a potentially life-saving operation—available to more patients, including some who had cancer.
Four months after receiving a transplant, Kedian, 59, told The Associated Press, “People need to keep their voice.” He was still hoarse but could carry on an hour-long discussion. “I want everyone to know that this is possible.”Speaking about the first time he called his 82-year-old mother following surgery, “and she could hear me,” he broke down in tears. “That was important to me, to talk to my mother.”
There will only be nine additional participants in this tiny trial. However, it could teach researchers the best techniques for doing these difficult transplants, opening the door to the possibility of using them to help more patients in the future who are unable to talk, swallow, or breathe because of a damaged or missing larynx.
“People get extremely withdrawn and somewhat cut off from the outside world,” stated Dr. David Lott, the head and neck surgery chair at Mayo Clinic in Phoenix. “My patients tell me, ‘Yeah I may be alive but I’m not really living,'” which is why he began the research.
Early post-operative data were published by Lott’s team in the journal Mayo Clinic Proceedings on Tuesday. Although it is most commonly associated with the voice box, the larynx is also necessary for breathing and eating. Vocal cords are flaps of muscular tissue that open to let air into the lungs, close to stop food or liquids from flowing the wrong way, and vibrate to make speech as air pushes past them.
The initial two patients of larynx transplants in the United States, who received their surgery at the Cleveland Clinic in 1998 and the University of California, Davis in 2010, were both injured, one from a motorbike accident and the other from a hospital ventilator. The main cause, though, is cancer. More than 12,600 people are expected to receive a laryngeal cancer diagnosis this year, according to the American Cancer Society. Many individuals now receive therapy to preserve their voice, but thousands of others have had their entire larynx removed, meaning they must breathe via a tube in their neck known as a tracheostomy tube and find it difficult to speak.
Despite the fact that the previous American receivers were able to speak almost normally, physicians have not accepted these transplants. That’s partly because immunosuppressive antirejection medications may cause tumours to grow or recur, yet people may live without a larynx. As far as possible, we want to be able to push those boundaries while still acting morally and securely, according to Lott.
Experts in head and neck surgery assert that the Mayo study is essential to making larynx transplants a practical choice. “It’s not a ‘one-off,'” but rather a chance to learn from one patient before operating on the next, according to Dr. Marshall Strome, the transplant team leader in Cleveland in 1998. According to him, this initial effort in a cancer patient “is the next important step.”
According to Dr. Peter Belafsky of UC Davis, who assisted with the 2010 transplant, there are other possibilities under investigation. His high-risk larynx-losing patients record their voice in anticipation of speech-imitating technology of the future. However, Belafsky cautioned that it would probably require years more research and said there’s “still a shot” for larynx transplants to become more widespread. A challenge has been regrowing enough nerves to breathe without the need for a tracheostomy tube. About ten years ago, Kedian was diagnosed with a rare kind of cancer of the larynx.
After undergoing over a dozen operations, the guy from Haverhill, Massachusetts, finally required a trach tube to aid with his breathing and swallowing. He even found it difficult to speak in a hoarse mumble through the tube. Due of his handicap, he had to retire. Despite being known for engaging in lengthy chats with strangers, Kedian, who was formerly outgoing, refused to allow surgeons to remove his entire larynx in an attempt to treat his illness. He yearned to tell bedtime stories to his granddaughter in his own voice, away from what he perceived as artificially artificial speech machines.
Next, Kedian’s spouse Gina located the Mayo research. Because Kedian’s cancer wasn’t progressing quickly and, more crucially, because he was already on antirejection medication for a previous kidney transplant, Lott determined that he was a good candidate. Finding a dead donor with a sufficiently healthy larynx that was the ideal size took ten months. After that, six surgeons performed for 21 hours on February 29. Following the removal of Kedian’s malignant larynx, the donor larynx was transplanted together with the required adjacent tissues, including the pharynx, upper section of the trachea, thyroid, and parathyroid glands, as well as the small blood arteries that supplied them.
Ultimately, they linked the nerves that Kedian needs to sense when he wants to swallow and move his voice chords using innovative microsurgical methods. After about three weeks, Kedian greeted me. He quickly acquired the ability to swallow again, progressing from applesauce to macaroni and cheese to hamburgers. He was able to greet his granddaughter Charlotte over video chat, fulfilling his assignment to never stop chatting.
“Every day is improving,” Kedian, who will shortly return to Massachusetts, said. “I’m pushing myself to make it go faster because I want these tubes out of me, to go back to a normal life,” he says, even though his tracheostomy will be in place for at least a few more months. And Kedian kept his cherished Boston accent, just as Lott had told him.
-Raja Aditya
