When Sherry Wittenberg was diagnosed with a rare cancer in the cricoid cartilage of her larynx, doctors told her the only way to treat the condition was to remove her voice box. The operation would leave her unable to speak normally and would require her to breathe through a hole in her neck for the rest of her life.
But Wittenberg, who lives in Cement City, MI, sought a second opinion at the University of Michigan Health System, where Douglas Chepeha, MD, MSPH, offered her an alternative: the option of undergoing a new procedure that, if successful, would allow her to keep her voice.
The technique, detailed in Laryngoscope (December 12, 2011), reconstructs a ring of cartilage in a patient's neck called the cricoid with a slice from the tip of one shoulder blade.
"The biggest challenge is that doctors have never been able to rebuild a cricoid cartilage so that the patient can breathe through it," said Dr. Chepeha, director of microvascular surgery in the department of otolaryngology, head and neck surgery at the University of Michigan Medical School. "The reconstruction has to be both strong and thin. It has to hold the larynx and the components of the larynx together, and still be open so that the patient can breathe through it."
The curved tip of a patient's scapula provides the right combination of attributes, according to Dr. Chepeha. And the blood vessels feeding the scapula tissue are left intact.
"We had to carve this piece of her shoulder a little bit and then put it in her airway," he said. "When you do a transplant from one part of the patient's body to another, you don't have the risk of rejection you would have with an outside donor."
A graft of tissue from the inside of Wittenberg's mouth was used to help reconstruct the lining of her larynx. Within just three months, she was able to return to work, her voice intact and her larynx cancer-free.
Today, Wittenberg's breathing has returned to normal and her speech is very close to what it was before the operation, she said.
"The only difference is that my voice doesn't have quite the same volume it did before," she said.
