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Massachusetts General Hospital (MGH) surgeons have developed a newtechnique for reconstructing the larynx after surgery for advanced cancer . In the May Annals of Otology, Rhinology and Laryngology , they describe how this approach - which uses cryopreserved aortasfrom deceased donors to replace removed larynx tissue - allowedpatients to avoid a permanent tracheotomy and maintain voice andswallowing function with no need for immunosuppressive medications.The pioneering surgery was a collaborative effort between StevenZeitels, MD, director of the MGH Center for Laryngeal Surgery, andJohn Wain, MD, surgical director of the MGH Lung TransplantationService. "Without this new reconstructive technique, most of these patientswould have required a total laryngectomy," says Zeitels,corresponding author of the report. "I don't believe anything likethis has been achieved before - especially for larynx cancerreconstruction in patients whose tumors recurred afterradiotherapy." Although small laryngeal tumors can be successfully removed throughminimally invasive laser surgery or treated with radiation,advanced tumors require more invasive procedures to remove theaffected area, especially when chemotherapy and radiation havefailed as initial treatment. In these situations, problems with thehealing of tissues previously exposed to radiation and the lack ofreliable reconstructive techniques have meant that a majority ofpatients having partial laryngectomy still needed a permanenttracheotomy - an opening through the neck and into the trachea -resulting in substantial voice and swallowing dysfunction. Sincethe quality of life would probably be better with removal of theentire larynx, patients and their surgeons often chose a totallaryngectomy. To address the reconstructive limitations of partial laryngectomy,Zeitels and Wain developed an approach using the body's largestblood vessel, the aorta, to reconstruct the larynx. The MGHsurgeons first used a previously frozen aortic graft forreconstruction after partial laryngectomy for recurrent cancer in2009. Over the next two years, they performed the procedure on 15patients, 8 of whom had previously received radiation therapy. Allof these procedures were performed in one operation, combining boththe tumor removal and reconstruction at the same time, and noimmunosuppressive medications were needed. Of that initial group of patients, all were able to have theirpostoperative tracheotomy tubes removed and resume breathingnormally. All resumed speaking without the need for assistivedevices, although their vocal quality depended on how much tissuehad been removed, and all but one recovered and maintainedswallowing function. Two patients had recurrence of their advancedtumors that required subsequent total laryngectomy. No stents wereneeded to keep patients' airways open, unlike in pilot trials usingsimilar aortic grafts to reconstruct the trachea, which have hadlimited success. "The shape of the aorta, which approximates that of the removedlaryngeal tissue, and its ability to serve as a surface for healingwithin the airway are unique characteristics of these grafts thatother forms of reconstruction do not provide," says Wain. Zeitels adds, "The success of this procedure is remarkable, sincethe aortic tissue has held up extremely well against the stressesof a non-sterile environment, exposure to refluxing stomach fluidsand the mechanical forces of swallowing and coughing. Given thesuccess in this extremely challenging surgical scenario, it'slikely that there will be many other uses for cryopreservedvascular grafts as supportive structures and tissue patches forsurgery in other parts of the body." Additional References Citations. We are high quality suppliers, our products such as Holy Quran Read Pen Manufacturer , Muslim Azan Clock Manufacturer for oversee buyer. To know more, please visits Arabic Alphabet Chart.
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