Orthotopic laryngeal transplantation: is it time?

The notion of returning phonatory and respiratory function by transplanting larynges has fascinated and challenged the minds of laryngologists for many years. In the past, the problems of revascularization, tissue rejection, and physiologic vocal fold motion have stymied the success of research in this area. Today, advances in microvascular surgery, graft versus host response, and selective reinnervation have made laryngeal transplantation a theoretical, if not a practical reality. Despite this progress, serious ethical and fiscal considerations remain unresolved. This report will discuss these advances as well as concerns and will present the current UCLA laryngeal physiology laboratory experience with canine laryngeal transplantation.