Selective reinnervation of paralyzed musculature in the head and neck: functioning autotransplantation of the canine larynx.

Abstract

Previous work has demonstrated the possibility of reinnervation of paralyzed muscle groups in the head and neck by the nerve‐muscle pedicle technique. The ability to transplant a human larynx would be feasible if three problems could be overcome. The first of these is the reestablishment of blood supply, most of which problem has already been solved by the work of Ogura and others. The second is the need to restore function of the vocal cords sufficient to provide the necessary valve action of the larynx. It would then be able to maintain airway, prevent aspiration and restore some use of the voice. Previous work by the present author and others has demonstrated that the nerve‐muscle pedicle technique can theoretically be applied to reinnervate a transplanted larynx. The third problem, that of immunosuppression, remains to be solved.The experiment reported in this paper successfully combines the first two of these criteria in reimplantation of totally excised canine larynges. It follows logically that, if a means of immunosuppression satisfactory for use in human beings who have recently had a malignant process could be found successful human laryngeal transplantation would be a realistic possibility.