Laryngeal Transplantation in 2005: A Review

Abstract

There is no good surgical, medical or prosthetic solution to the problems faced by those with a larynx whose function is irreversibly damaged by tumor or trauma. Over the past 10 years, the pace of research designed to establish laryngeal transplantation as a therapeutic option for these persons has increased steadily. The biggest milestone in this field was the world's first true laryngeal transplant performed in Cleveland, Ohio in 1998. The recipient's graft continues to function well, in many respects, even after 7 years. However, it has also highlighted the remaining barriers to full-scale clinical trials. Stimulated by these observations, several groups have accumulated data which point to answers to some of the outstanding questions surrounding functional reinnervation and immunomodulation. This review seeks to outline the progress achieved in this field by 2005 and to point the way forward for laryngeal transplantation research in the 21st century.

Early immunological changes associated with laryngeal transplantation in a major histocompatibility complex-matched pig model

“…However, recent advances have made laryngeal transplantation an increasingly viable proposition for patients with irreversible laryngeal disease [5]. One successful human laryngeal transplant has been performed and the 40-month follow-up report was encouraging [6].…”

Tongue Transplantation

“…Although the greatest need for tongue reconstruction exists in patients with head and neck cancer, the most recent cases of total face and tongue allotransplantation for trauma suggests a new application for tongue allotransplantation. The future of composite tissue allotransplantation-tongue, larynx, face, or hands-may depend upon the development of organ-specific immunosuppression strategies and improved techniques for reinnervation [19]. But, the reconstructive goal remains the same: restore form and function with minimal morbidity to the patient.…”

“…But, it was not the finely coordinated movements of the native tongue. As with the first human larynx transplant, the first canine tongue transplant did not yield physiologically useful movement [16,19]. Additionally, Haughey demonstrated lingual nerve regeneration suggesting the potential for sensory recovery-a finding that is also seen in face transplant recipients who have regained facial sensation [16, 20 • …”

“…While the development of allotransplantation remains a landmark event in head and neck reconstruction, the potential application is limited by the morbidity of immunosuppression. The ideal composite tissue allotransplant recipient is a young healthy patient with a tissue deficit following a traumatic injury, a benign tumor resection or who is already on a post-transplant immunosuppression regimen [19]. The indication for tongue allotransplantation would be significant functional deficit following total or subtotal loss of tongue tissue with graftable hypoglossal and lingual nerves in the absence of other contraindication to oral intake.…”

“…The complexity of tissue defects of the head and neck has fueled the development of composite tissue allotransplantation as a potential solution to these challenging problems [18,19,20 • ]. While the development of allotransplantation remains a landmark event in head and neck reconstruction, the potential application is limited by the morbidity of immunosuppression.…”