Researchers from three continents have recently summarized the global experience in laryngeal transplantation. A total of 11 cases between 1998 and 2022. Eleven cases in 25 years, worldwide.
The paper starts remarking an indisputable fact: “Loss of laryngeal function impairs vital human social and functional abilities, especially communication, respiration, and swallowing“. That is true. The larynx is basically an sphincter with three critical roles: airway protection during swallowing (closed configuration), airway patency (opened configuration), and phonation (closed configuration).
The loss of the larynx profoundly impacts the quality of life.
The most common reason for loosing the larynx is laryngeal cancer. Laryngectomy is required to control the disease under certain circumstances is patients with advanced tumours. Indeed, it is a highly effective oncologic treatment and many patients will be long-term survivors. A significant portion of healthcare efforts for these patients focuses on rehabilitation. We have developed considerable expertise in this area. Most patients achieve normal swallowing with a regular diet and good voice quality using voice prostheses. However, the tracheostoma remains a necessary consequence.
The primary motivation behind developing laryngeal transplantation was to eliminate the need for a tracheostoma. While technically feasible, the transplanted larynx remains dysfunctional. It needs to be able to open and close to function as a larynx. And we cannot solve that even in patients with his/her own larynx when de laryngeal nerves or the dynamics of the larynx are damaged. Suturing the nerve alone is insufficient; successful reinnervation requires that every nerve fibre connects precisely with its target muscle, a feat currently beyond our capabilities. Plus, surgical morbidity and the consequences of immunosuppression required for composite tissue transplantation. A mechanical bionic larynx might offer a solution sooner than achieving a functional biological reinnervation.
The larynx is not a vital organ. As every otolaryngologist knows, in terms quality of life, it is much better not to have a larynx than to have a dysfunctional one.
J Granell. July 9th, 2024.
Candelo E, Belafsky PC, Corrales M, Farwell DG, Gonzales LF, Grajek M, Walczak DA, Strome M, Lorenz RR, Tintinago LF, Velez MA, Victoria W, Birchall M. The Global Experience of Laryngeal Transplantation: Series of Eleven Patients in Three Continents. Laryngoscope. 2024 Jul 6. doi: 10.1002/lary.31551. Epub ahead of print. PMID: 38970445.
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