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Lott DG, Mour GK, Grandjean DN, Zacharias SRC, Stearns EH, Chang BA, Entezami P, Hinni ML, Howard BE, Zheng M. Total Laryngeal Transplant in the Setting of Active Laryngeal Malignancy. Mayo Clin Proc 2024; 99:1445-1448. [PMID: 39115512 DOI: 10.1016/j.mayocp.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 09/06/2024]
Abstract
Laryngeal transplant (LT) is a promising option to restore quality of life in patients with severe laryngeal dysfunction or a laryngectomy. These patients may be tracheostomy tube dependent or gastrostomy tube dependent and may lose their ability to verbally communicate. The loss of these important functions frequently results in social isolation and a severe decrease in quality of life. Laryngeal transplant has the potential to restore all of these important laryngeal functions. Herein, we report the first known documented LT performed in the setting of laryngeal chondrosarcoma.
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Affiliation(s)
- David G Lott
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix; Center for Regenerative Biotherapeutics, Mayo Clinic Arizona, Phoenix; Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Phoenix.
| | - Girish K Mour
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Division of Nephrology, Mayo Clinic Arizona, Phoenix
| | - Danielle N Grandjean
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Center for Regenerative Biotherapeutics, Mayo Clinic Arizona, Phoenix; Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Phoenix
| | - Stephanie R C Zacharias
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix; Center for Regenerative Biotherapeutics, Mayo Clinic Arizona, Phoenix; Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Phoenix
| | | | - Brent A Chang
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
| | - Payam Entezami
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
| | - Michael L Hinni
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
| | - Brittany E Howard
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
| | - Melissa Zheng
- Larynx and Trachea Transplantation Program, Mayo Clinic Arizona, Phoenix; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
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Céruse P, Vergez S, Marie JP, Baujat B, Jegoux F, Malard O, Albert S, Badet L, Blanc J, Deneuve S, Faure F, Fuchsmann C, Morelon E, Philouze P. Laryngeal graft after total laryngectomy in humans: A SWiM analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:81-85. [PMID: 38135563 DOI: 10.1016/j.anorl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Evaluation of the results of laryngeal transplantation (LT) in humans. Analysis of 3 bibliographic databases with the keywords "larynx, transplantation, autograft". In total, 626 abstracts were read and 25 articles selected. The main objective was to analyze the characteristics of laryngeal transplant patients. The accessory objectives comprised analysis of operative technique, immunosuppressive treatment and results. Four articles were selected for analysis. Two patients were transplanted after total laryngectomy for laryngeal carcinoma and 2 after laryngeal trauma. Three of the 4 patients had true transplantation with arterial, venous and neural microanastomosis. Two patients were decannulated and the tracheostomy tube was maintained in the other 2. Three of the 4 patients had good-quality phonation and could feed without a gastric tube. One patient died of carcinoma progression and 1 patient had to be explanted 14 years after transplantation. The number of LTs reported is too small for scientific determination of the place of this intervention in laryngology. The published results could, at first sight, suggest that the future of LT is uncertain. However, several elements, also suggest that otolaryngologists should continue to take an interest in this technique.
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Affiliation(s)
- P Céruse
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France.
| | - S Vergez
- Centre Hospitalo-Universitaire de Toulouse, Hôpital Larrey, Toulouse, France
| | - J-P Marie
- Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - B Baujat
- Centre Hospitalo-Universitaire de Tenon, Paris, France
| | - F Jegoux
- Centre Hospitalo-Universitaire de Rennes, Rennes, France
| | - O Malard
- Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - S Albert
- Groupe Hospitalier Ambroise-Paré, Paris, France
| | | | - J Blanc
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | - S Deneuve
- Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - F Faure
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | - C Fuchsmann
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
| | | | - P Philouze
- Centre Hospitalo-Universitaire Lyon Nord, Hospices Civils de Lyon, Lyon, France
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Abstract
OPINION STATEMENT The task of surgical research is to improve the efficacy of available surgical therapeutic modalities, develop new ones, and balance this well with favorable functional outcome. Therefore, surgical research is composed of a translational and a clinical component. In translational surgical research, animal models are used to better understand the biology of head and neck cancers, but even more importantly, the biology of changes to the disease and the microenvironment created by surgical interventions. Animal models additionally allow for the development of image-guided surgery systems, novel strategies of intraoperative adjuvant treatment, and patient "avatars" to test innovative anticancer drug combinations. In clinical surgical research, surgical techniques are validated in clinical trials for effectiveness of tumor control and improvement of functional recovery of the patient. In conclusion, surgical research for head and neck cancer is an active field spanning across the entire breadth of basic and clinical science devoted to a better understanding of what surgery does to the disease and to the patient.
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Affiliation(s)
- Genrich Tolstonog
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Christian Simon
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
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Krishnan G, Du C, Fishman JM, Foreman A, Lott DG, Farwell G, Belafsky P, Krishnan S, Birchall MA. The current status of human laryngeal transplantation in 2017: A state of the field review. Laryngoscope 2017; 127:1861-1868. [PMID: 28224630 DOI: 10.1002/lary.26503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Human laryngeal allotransplantation has long been contemplated as a surgical option following laryngectomy, but there is a paucity of information regarding the indications, surgical procedure, and patient outcomes. Our objectives were to identify all human laryngeal allotransplants that have been undertaken and reported in the English literature and to evaluate the success of the procedure. DATA SOURCES MEDLINE, Embase, Current Index to Nursing and Allied Health Literature, Web of Science and Scopus, and the Gray literature. REVIEW METHODS A comprehensive search strategy was undertaken across multiple databases. Inclusion criteria were case reports of patients who had undergone human laryngeal allotransplantation. Information regarding indications, operative techniques, complications, graft viability, and functional outcomes were extracted. RESULTS A total of 5,961 articles, following removal of duplicates, matched the search criteria and were screened, with five case reports relating to two patients, ultimately fulfilling the entry criteria. CONCLUSIONS Two laryngeal transplants have been reported in the medical literature. Although both patients report improved quality of life relating to their ability to communicate with voice, further research is necessary to shape our understanding of this complicated operation, its indications, and its functional outcomes. Laryngoscope, 127:1861-1868, 2017.
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Affiliation(s)
- Giri Krishnan
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Charles Du
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan M Fishman
- Department of Otolaryngology-Head and Neck Surgery, UCL Ear Institute, University College London, London, United Kingdom
| | - Andrew Foreman
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David G Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Gregory Farwell
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Martin A Birchall
- Department of Otolaryngology-Head and Neck Surgery, UCL Ear Institute, University College London, London, United Kingdom
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What is the future of 'organ transplantation' in the head and neck? Curr Opin Otolaryngol Head Neck Surg 2015; 22:429-35. [PMID: 25101936 DOI: 10.1097/moo.0000000000000087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To update readers on the current state and future of head and neck tissue transplantation. RECENT FINDINGS Many exciting advances have recently occurred in the field of head and neck transplantation and regenerative medicine. Larynx, face, and trachea transplants have all been successfully performed. Significant advancements in tissue engineering have occurred, including the ability to generate three-dimensional tissue structures. Transplantation of regenerated tissues has been successfully incorporated into airway reconstruction. SUMMARY These exciting advancements set the foundation to expand reconstructive options for dysfunctional tissues and to improve a patient's quality of life.
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Is open surgery for head and neck cancers truly declining? Eur Arch Otorhinolaryngol 2013; 270:2793-802. [DOI: 10.1007/s00405-012-2322-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022]
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