After eleven years, Brenda Jensen is finally able to speak with her own voice, but she's using someone else's larynx to do it. Over a two day period in October at the UC Davis Medical Center, nearly two dozen medical professionals worked to transplant a larynx (voice box), thyroid, and trachea into Jensen. The 52 year old woman had damaged her own larynx after repeatedly pulling out a breathing tube during a hospital stay eleven years prior. She's spent the last decade breathing through a tracheotomy tube and speaking with a handheld device that made her sound like a robot. Now, she feels human once again. Her team of surgeons recently gave a press conference on her case. You can hear Brenda Jensen for yourself in the two news clips below. This remarkable surgery is just the latest example of how medicine will one day be able to replace or repair any part of your body.
Jensen's 18 hour operation took place over two days and featured a dream team of doctors from the US and Europe. The delicate procedure required the surgical team to connect the implanted trachea, thyroid, and larynx to both the cardiovascular and nervous system - including five nerves, three arteries, and two veins. As remarkable as this highly precise surgery was, it was actually the second larynx transplant on record. The first was performed in 1998 on Tim Hiedler (aged 40) at the Cleveland Clinic. As with Hiedler, Jensen's post-transplant voice is her own. A person's unique sound is decided by the nose, throat, and mouth, not necessarily the vocal chords.
In the three months since her surgery, doctors report Jensen is doing well. According to UC Davis Medical Center, she will continue to breathe through the tracheotomy tube and eat through a feeding tube until her throat can be trained to swallow, inhale, and exhale properly. She may take considerable time to fully recover, but doctors believe that she will eventually be able to eat, drink, speak, and breathe normally. She'll even be able to swim again, something Jensen has had to avoid (along with showers) for more than a decade.
What makes Jensen's story so remarkable, besides her obvious joy at reclaiming her voice, is how rarely such transplants are attempted. Due to the nature of the replacement parts being donated from someone else, Jensen is required to be on immunosuppressants for the rest of her life. As she is already a kidney and pancreas transplant recipient, however, she was faced with such a regimen anyway. Also, in the last few decades, throat surgery has progressed such that many incidences of injury to the larynx can be fixed without a transplant. Improvements in chemotherapy have likewise reduced the prevalence of people who lose their voices due to throat cancer.
So is this surgery simply a fluke? A bizarre testament to the surgical advances of the past quarter century? No, it's a bit more. During the complex and delicate operation, and over the long period of rehabilitation, Jensen's transplant gives doctors a look into the workings of the human throat. The nerve connections, the blood vessel connections, the process for gaining control of the larynx - these provide new insights that will inspire other surgeries and techniques. According to Paolo Macchiarini, one of the surgeons involved, "Not only is it highly relevant for future transplants, it offers us insights that may one day lead to using stem cells to repair the voicebox and surrounding areas in the throat."
When it comes to stem cells and the throat, Macchiarini knows what he's talking about. Last year he was the leader of a team that grew a new trachea in a 10 year old boy using the child's own stem cells. As he stated in regards to the Jensen case, “Being able to restore nerves and reconnect blood vessels in and around the larynx and trachea, and have it all work, was a real test.” Perhaps this most recent operation will lead to further remarkable work from Macchiarini in the near future.
Whether it incorporates stem cells, bionic devices, or animal spare parts, the future of surgery is going to become even more complex and far-ranging. We've already seen hand transplants, full face transplants, and dozens of other complicated procedures that would have seemed mythical had they been attempted fifty years earlier. Some progress will come from improved surgical instruments (including robots), some will arise from improved knowledge of cells, but much of it could still come from simple human ingenuity. The opportunities for ground-breaking transplants such as this one may be rare, but they will provide the fuel for many more medical innovations in the future. Congratulations on your restored voice Ms. Jensen, and best wishes to everyone on this project.
[image credits: UC Davis Medical Center]
[sources: UC Davis Medical Center, ABC News]