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The woman who found her voice

A woman who had lost her voice during surgery was finally able to speak her first words in 11 years after a pioneering voice box transplant was successfully performed. This is only the second successful larynx and thyroid transplant ever performed the first dating back to 1998. The operation was performed at the Medical Centre of the University of California in October.

The complex anatomy of the larynx (Diagram: nlm.nih.gov)

Brenda Charett Jenson lost her voice 11 years ago after complications during surgery blocked her airway. She was not only merely able to communicate through a voice synthesiser, but also dependent on a tracheotomy (a tube is inserted into a windpipe) for breathing. Compared to that of the previous transplant patient, Jensen’s progress is immense. Although he has recovered some speech, he still has a tracheotomy and has never been able to move his own vocal cords. So what made Jensen the ideal candidate for this ground-breaking surgery?

Firstly, Jensen was already on immunosuppressive drugs due to a kidney-pancreas transplant. Immunosuppressive drugs target the immune system in a bid to reduce the risk of organ rejection. Organ rejection is the most common problem with transplants, the body’s system generally not being very compliant when faced with unknown organs or blood. A good example of this is blood type between mothers and children. Blood types are categorised in two ways. First in letter types (A, B, AB or O) and secondly depending on the presence or absence of a particular protein Rh.

In most cases, a pregnant woman’s blood and the foetus’s blood will not mingle, but at birth if an Rh negative mother gives birth to an Rh positive baby, the woman’s body can react against the Rh proteins entering her blood and create antibodies sent to fight the proteins. This is not a problem for the first birth, but if the mother were to become pregnant again with a Rh positive baby, her immune system would immediately create antibodies to fight off the unwanted proteins and the baby carrying them. Fortunately, a double injection of RH-immune globins during the first pregnancy, act as a vaccine and avoid complications to both the newborn and future pregnancies.

Another reason for this surgery’s breakthrough success is that a more complex organ was transplanted. “The first larynx transplant only reconnected three nerves”, according to martin Birchall of UCL, whereas this procedure connected “five nerves with the intention of restoring much more laryngeal function than the original and, eventually getting rid of the tracheotomy.” The team transplanted the larynx, thyroid and trachea of a woman who died in an accident. The operation, which lasted 18 hours, was lead by a team of specialised doctors which had trained for 2 years in preparation.

Thirteen days after her operation, Jenson spoke her first words, congratulating her doctors on how amazing they were. Although she still requires the use of her tracheotomy, the hope is that she will learn to breathe without it. She is still learning to swallow properly but already says “This operation has restored my life. I feel so blessed to have been given this opportunity.”

This operation follows a series of leaps in the transplant world. From the first successful face transplant in 2005, extensive research is being undergone in various fields surrounding the area. The transplants are becoming more and more complex but are involving a greater overall benefit as they endeavour to involve bones, muscle and nerves in the transplant. This makes the operations more ambitious but also more likely to stick. A lot of research is also being done into the value of stem cells within organ transplants and how to use a recipient’s stem cells to help ease the donor’s organ into the body.

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