Total Larynx Transplant

The larynx, also known as a voice box, is a hollow tube located in the middle of your neck. Your larynx allows you to make sounds and enables air to pass through your throat, trachea, and into your lungs. Damage to the larynx can cause patients to lose their abilities to communicate effectively. On July 9th, 2024, the third official total larynx transplant was achieved in the United States by a team at Mayo Clinic in Arizona. This surgery totaled six surgeons and 20 support staff over a duration of 21 hours. Unlike the previous two surgeries, this surgery was especially significant due to it being performed on an active cancer patient. 

How does this procedure work? First, a donor larynx is required. Prior to the surgery, the patient receives cyclosporine as well as azathioprine (two immune system repressors that allow a patient's body to accept transplants), and methylprednisolone (medication to reduce swelling and inflammation). Then, the laryngeal vasculature and innervation are mapped out and well described.

When surgery begins, the strap muscles, hyoid bone, and preepiglottic fat are removed from the donor’s larynx. Perfusion (a procedure where blood is transported throughout an individual's body) is conducted before the recipient's larynx is removed. The donor's right superior thyroid artery and the patient's right superior thyroid artery are then linked. The proximal end of the donor's right internal jugular vein is also linked to the end of the patient's. The distal end of the donor's jaguar vein is sewn. Within 30 minutes, blood flow through the thyroid gland, six tracheal rings, larynx, and pharynx should be seen. After blood flow is visible, a narrow-field laryngectomy is performed, and a portion of the patient's trachea is removed. The patient’s thyroid is split and repositioned laterally. The patient's pharynx is widened, and three permanent sutures, each 1 cm apart, are placed between the patient's hyoid bone and the donor’s thyroid cartilage. 5 tracheal rings are needed to reach the patient’s tracheal stoma. The left superior thyroid arteries are linked to each other by an end. The left middle thyroid vein of the transplant is linked to the end of the patient's left internal jugular vein. Lastly, both superior laryngeal nerves and the right recurrent laryngeal nerve of the transplant are stitched to those of the patient. 

The day after surgery, the tracheostomy tube and operative drains are removed. The patient is given glycopyrrolate and atripine to help reduce salivary secretion. For 14 weeks, the patient is fed through a gastrotomy tube. As a result of the 21-hour surgery conducted by Mayo Clinic, the patient was able to utter his first words in 20 years, just three days post-operation. 

Written by Urvi Vora at Incisionary

APA References

Cleveland Clinic. (2021, October 13). Larynx (Voice Box): Anatomy & Function. Cleveland Clinic. https://my.clevelandclinic.org/health/body/21872-larynx

Hames, M. V. (2024, July 9). Mayo Clinic marks medical milestone with world’s first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial. Mayo Clinic News Network.

https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-marks-medical-milestone-with-worlds-first-known-successful-total-larynx-transplant-performed-in-a-patient-with-an-active-cancer-as-part-of-a-clinical-trial/

Imuran Information : Azathioprine : Johns Hopkins Arthritis Center. (2016). Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/patient-corner/drug-information/azathioprine-imuran/

Mayo Clinic. (2020). Cyclosporine (Oral Route) Description and Brand Names - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/drugs-supplements/cyclosporine-oral-route/description/drg-20075815

Methylprednisolone tablets. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/19300-methylprednisolone-tablets

Print. (n.d.). Larynx and Trachea Transplant Program in Arizona - Overview. Mayo Clinic. https://www.mayoclinic.org/departments-centers/larynx-trachea-transplant/overview/ovc-20508897

Sakallıoğlu, Ö. (2015). Laryngeal Transplantation. Turkish Archives of Otorhinolaryngology, 53(3), 128–132. https://doi.org/10.5152/tao.2015.999

Simmons, L. (2024, July 10). Cancer Patient Gets Total Larynx Transplant To Restore His Voice In World First. IFLScience. https://www.iflscience.com/cancer-patient-gets-total-larynx-transplant-to-restore-his-voice-in-world-first-75032

Strome, M., Stein, J., Esclamado, R., Hicks, D., Lorenz, R. R., Braun, W., Yetman, R., Eliachar, I., & Mayes, J. (2001). Laryngeal Transplantation and 40-Month Follow-up. New England Journal of Medicine, 344(22), 1676–1679. https://doi.org/10.1056/nejm200105313442204

Team at Mayo Clinic in Arizona completes first larynx transplant - Mayo Clinic. (2024). Mayoclinic.org. https://www.mayoclinic.org/medical-professionals/transplant-medicine/news/team-at-mayo-clinic-in-arizona-completes-first-larynx-transplant/mac-20575468