Friday, April 19, 2019
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First total laryngeal transplant

40-year-old Timothy Heidler’s first “Hello” is a medical milestone.

On January 7, 1998, Timothy Heidler made medical history with a simple, raspy “Hello.” Just three days earlier, a team of specialists at the Cleveland Clinic performed the country’s first total laryngeal transplant, ending Mr. Heidler’s 19 years of silence.

Mr. Heidler had been speaking with only the aid of an electrolarynx, a hand-held speech assist device, since 1978 when, at age 21, his larynx was severed in a motorcycle accident. He was on his way to a firefighters’ class in his hometown of Hollidaysburg, PA, when he struck a steel cable strung between two trees. He walked away from the accident but he was left unable to speak.

“I was very, very frustrated at not being able to talk. My goal is to talk again in a real voice,” said Mr. Heidler, via an electronic speech device, in an interview prior to his surgery.

The procedure that helped him reach that goal was “truly a special occasion,” said Marshall Strome, M.D., chairman of the Clinic’s Department of Otolaryngology and Communicative Disorders and leader of a team of eight surgeons, anesthesiologists and nurses who performed the 12-hour operation.

During Mr. Heidler’s procedure, the Clinic team transplanted the larynx, the thyroid and 70 percent of the throat of the donor. The only other attempt at a human laryngeal transplant was 25 years ago in Belgium. However, the individual, a cancer patient, died from the disease a short time following the surgery.

“Some say that we shouldn’t perform this type of transplant because the larynx is a non-vital organ. But Tim is a very bright, verbal and motivated man who risked his life to speak as other people do. A great deal of research has been done since the first attempt and it is a very different operation today, ” says Dr. Strome.

The operation may be an option for patients who have large non-cancerous tumors in the larynx, or for patients whose laryngeal cancer is cured but who are unable to speak in a normal voice.

The transplant procedure involves harvesting a donor larynx using the same selection and administrative procedures for other organs through LifeBanc, a northeast Ohio organ donation agency. The donor larynx, which is matched to the recipient by gender, must be harvested within 20 hours. After removing the diseased larynx, the donor larynx is sutured in place, the blood vessels and sensory nerves joined and a temporary tracheotomy created. In Mr. Heidler’s case, the donor had a perfect tissue and blood type match.

Following surgery, Mr. Heidler, like other transplant patients, underwent intense medical management to reduce the risk of organ rejection, including taking strong immunosuppressive drugs. He will continue seeing his Clinic physicians frequently. Dr. Strome will “relax” when Mr. Heidler is 10 years from transplant.

For now, the transplant team is extremely pleased with their patient’s progress. “To make vocal sounds in just two and a half days is incredible,” said Dr. Strome. “It was a very emotional experience for all of us when he said Hello,’ then Hi mom.’”

“I ran out and called his mother,” recalls Terri Ellenberger, Mr. Heidler’s girlfriend. “She was crying. She couldn’t believe he was talking just like the rest of us. It happened so quickly.”

In a news conference Jan. 29, prior to his release from the hospital, Mr. Heidler took questions from the media. While his responses were raspy, his words were clearly understandable. Within about six months he will have a new voice – a unique sound not like his old voice, nor that of his donor. Dr. Strome is optimistic that Mr. Heidler will be able to swallow food within three months.

“After 20 years of not being about to talk, making the decision to go ahead with this was real easy,” said Mr. Heidler at the news conference. “I felt if this transplant could be done, it would benefit a lot of people down the road.”

He still hopes to become a fireman – something he can now consider again since he has his voice back. “Being able to speak again has changed my whole life.” His hometown is cheering him on. Upon his return home from Cleveland, he was greeted to a party complete with the local fire engine.

“This is the best that I’ve felt in a long time.”

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