A Massachusetts man has regained his voice after surgeons removed his cancerous larynx and, in a pioneering move, replaced it with a given model.
Laryngeal transplants are extremely rare and are generally not an option for people with active cancer. Marty Kedian is only the third person in the United States to have undergone a total laryngeal transplant (the others, years ago, were due to injuries) and one of only a handful of such transplants in the world.
Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial aimed at opening the potentially life-changing operation to more patients, including some with cancer, the most common way to lose a larynx.
“People need to keep their voices,” Kedian, 59, told The Associated Press four months after his transplant. He is still hoarse but able to hold an hour-long conversation. “I want people to know that it is possible.”
He became emotional as he recalled the first time he called his 82-year-old mother after the operation “and she could hear me… It was important to me, to talk to my mother.”
Mayo Clinic via AP
The study is small (only nine people will be enrolled). But it could teach scientists best practices for these complex transplants, so that one day they can be offered to more people who can’t breathe, swallow or speak on their own because of a damaged or surgically removed larynx.
“Patients become very lonely and very isolated from the rest of the world,” says Dr. David Lott, chairman of Mayo’s division of head and neck surgery in Phoenix. He started the study because “my patients tell me, ‘Yeah, I may be alive, but I’m not really living.'”
Lott’s team reported the initial results of the operation Tuesday in the journal Mayo Clinic Proceedings.
The larynx may be better known as the voice box, but it’s also essential for breathing and swallowing. Flaps of muscle tissue called vocal cords open to let air into the lungs, close to keep food or drink from moving the wrong way, and vibrate as air passes through them to produce speech.
/ AP
The first two laryngeal transplant recipients in the United States — at the Cleveland Clinic in 1998 and at the University of California, Davis, in 2010 — lost their voices as a result of injuries, one from a motorcycle accident and the other damaged by a hospital ventilator.
But cancer is the leading cause of this problem. The American Cancer Society estimates that more than 12,600 people will be diagnosed with laryngeal cancer this year. While many people today undergo voice-sparing treatment, thousands have had their larynx completely removed, breathing through what’s called a tracheostomy tube in their neck and having difficulty communicating.
Although the first American recipients have regained near-normal speech, doctors have not yet embraced the transplants. That’s partly because patients can survive without a larynx, while anti-rejection drugs that suppress the immune system can trigger new or recurring tumors.
“We want to be able to push those boundaries, but do it in the safest and most ethical way possible,” Lott said.
Head and neck specialists say the Mayo trial is key to helping laryngeal transplants become a viable option.
“This is not a one-off, but an opportunity to finally learn from one patient before we operate on the next one,” said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.
This first attempt in a cancer patient “is the next important step,” he said.
Other options are under consideration, noted Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant. His patients at high risk of laryngeal loss record their voices in anticipation of next-generation speech devices that will sound like them.
But Belafsky said there was “still a chance” that larynx transplants could become more common, while cautioning that it will likely take years of additional research. One hurdle has been getting enough nerve regrowth to allow breathing without a tracheal tube.
Kedian was diagnosed with a rare cancer of the laryngeal cartilage About a decade ago, the Haverhill, Massachusetts, man underwent more than a dozen surgeries, eventually requiring a tracheotomy to help him breathe and swallow. He struggled to even utter a hoarse whisper through it. He had to retire on disability.
Kedian, once sociable and known for his long conversations with strangers, wouldn’t let doctors remove his larynx to treat his cancer. He desperately wanted to read bedtime stories to his granddaughter, in his own voice rather than what he calls robotic-sounding speaking devices.
Kedian’s wife, Gina, then found the Mayo study. Lott decided he was a good candidate because his cancer wasn’t progressing quickly and, importantly, Kedian was already taking anti-rejection drugs for a previous kidney transplant.
It took 10 months to find a deceased donor with a sufficiently healthy larynx of the right size.
On February 29, six surgeons operated on Kedian for 21 hours. After removing the cancerous larynx, they transplanted the donated larynx along with the necessary adjacent tissues (thyroid and parathyroid glands, pharynx, and upper trachea) and tiny blood vessels to supply them. Finally, using new microsurgical techniques, they connected the essential nerves so that Kedian could feel the need to swallow and move his vocal cords.
About three weeks later, Kedian said “hello.” He quickly learned to swallow again, moving from applesauce to macaroni and cheese to hamburgers. He was able to say hello to his granddaughter Charlotte via video, as part of his homework to keep talking.
“Every day it’s getting better,” said Kedian, who will soon return to Massachusetts. His tracheostomy will remain in place for at least a few more months, but “I’m trying to speed things up because I want to get these tubes out of me and get back to my normal life.”
And as Lott had assured him, Kedian kept his beloved Boston accent.