A California woman has spoken for the first time in 11 years after undergoing a voicebox transplant, one of the most complex transplant surgeries ever performed.
Surgeons from University of California (UC) Davis Medical Center told the press on Thursday that 52-year-old Brenda Charett Jensen from Modesto, California, underwent an 18-hour operation over a two-day period in October 2010, where they replaced her larynx (voicebox), thyroid gland and trachea (windpipe).
The larynx, an organ about the size of a fist, is located in the neck and is important for channeling air flow during breathing. It contains the vocal chords, which make us capable of speech.
Before the transplant, Jensen was not able to speak or breathe on her own, and just 13 days afterwards, she voiced her first words in 11 years and is now able to speak easily and at length, they said.
This is only the second documented case of such a transplant worldwide, they added. The other documented larynx transplant was carried out at the Cleveland Clinic in 1998.
Jensen, who has battled cancer and diabetes, had not been able to speak or breathe normally before the transplant because of complications from a previous surgery. This had closed off her airway so the only way she could breathe was through a tracheotomy tube. The tube is still there and visible at the base of her neck.
For over a decade the only way she could “speak” was via a handheld electronic gadget that sounds like a robot.
After the operation Jensen underwent two months of rehabilitation and although her restored voice sounds a little hoarse, it has improved signficantly because since the transplant her nerves have had to regrow in parallel with hear learning how to speak.
Jensen’s voice is her own, even though the voicebox she now has came from a female donor who had died in an accident.
Thanks to the new organ, Jensen can now smell and taste for the first time in years. She is currently learning how to swallow and should shortly be able to eat and drink normally once more.
In a statement, she said “the operation has restored my life”.
“I feel so blessed to have been given this opportunity,” she said, saying it was a miracle that she was talking, and her family and friends were amazed.
“I am deeply grateful to the donor and to the donor family for making this gift possible for me,” she added.
The lead surgeon of the transplant team, Gregory Farwell, who is associate professor of otolaryngology at UC Davis, said they were “absolutely delighted with the results of this extraordinary case”.
He explained that “the larynx is an incredibly complex organ, with intricate nerves and muscles functioning to provide voice and allow breathing”, and for a successful transplant you need an “exceptional, multi-disciplinary team”, and you have to use the latest surgical and rehabilitation techniques.
Plus, the patient has to be a person who relishes the “daunting challenges of undergoing the transplant and the work necessary to use her new voicebox,” he added.
It would seem all these factors came together in this remarkable case.
The transplant team comprised a total of nearly two dozen doctors, nurses, technicians, transplant coordinators, and other medical staff.
As well as Farwell, the surgical team included a number of international specialists, such as Paolo Macchiarini, professor of regenerative surgery at the Swedish medical university Karolinska Institutet; Martin Birchall, professor of laryngology at the University College London Ear Institute in the UK; Peter Belafsky, associate professor of otolaryngology at UC Davis Health System; and Quang Luu, assistant professor of otolaryngology at UC Davis Health System.
Belafsky, the principal project investigator for the transplant, was the one who first brought Jensen’s case to the attention of his colleagues. He stressed that this kind of transplant can only be done at academic health centers, because it requires extensive planning and a range of specialties.
Jensen’s condition was not life-threatening, so the transplant was an elective procedure.
Currently, not everyone whose larynx is either missing or not functioning can have a transplant because they have to take life-long drugs that suppress the immune system to stop it rejecting the new organ. This can result in several complications, and also increases the risk of developing cancer later on.
One of the reasons Jensen was a suitable candidate, was because she had undergone a kidney-pancreas transplant four years earlier, and was already taking anti-rejection medication.
Belafsky said another reason Jensen was “an exceptional candidate for the transplant”, was “because she was highly motivated”.
“That type of spirit is essential for success in a surgery with this degree of complexity,” he added, saying that anyone who had met her would know her as a “a strong and determined individual, with a terrific outlook on life despite the many physical challenges she’s faced over her lifetime”.
The transplant operation involved removing the larynx from the donor and removing and replacing Jensen’s larynx.
The team that removed the larynx from the donor worked in a room next to Jensen’s. They took away the whole larynx, thyroid and a 6-cm segment of the trachea. The thyroid gland is intricately entwined with the larynx and is critical for the blood supply to the new larynx and trachea.
After taking out the donor organ, the team tested it with a saline solution to check the health of the blood supply. The organ was then put in an ice saline solution, to await transplant.
Swallowing, using the vocal chords, and breathing are complex coordinated movements that require well functioning nerves and good blood perfusion: so correctly reattaching blood vessels and nerve fibers are a critical to success.
For this implanting part of the operation the surgeons used a double-sided microscope so they could work on both sides of the patient at the same time and suture the organ in place, a procedure that involved reconnecting five nerves, three arteries and two veins.
Jensen said every day was like “a new beginning”, adding that:
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!”
She said she was now working hard to use her vocal chords and train her muscles to swallow.
— More info, plus video and animation from UC Davis
Source: UC Davis Health System Newsroom (press release, 20 Jan 2011).
Written by: Catharine Paddock, PhD