A tissue-engineered implant for reconstructing part of the larynx has produced good results in vitro and in a canine, according to findings presented at the 2022 Triological Society Combined Sections Meeting in January 2022.
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March 2022The implant—the result of 10 years of work, according to the researchers—dangles the prospect of a new reconstruction option for laryngeal cancer. Total laryngectomies are frequently performed not because the cancer involves the entire larynx, said David Lott, MD, chair of the division of laryngology and professor of otolaryngology at the Mayo Clinic in Arizona, but because the defect that results after cancer removal is not able to be reconstructed in a way that provides normal laryngeal function. This implant allows for patient-specific reconstruction of hemilaryngeal or partial laryngeal defects to improve functional results, hopefully resulting in the need for fewer total laryngectomies. The effort earned the society’s Honorable Mention for Basic Science Award.
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“Total laryngectomy has many qualityof- life issues associated with it,” said Dr. Lott. “Hemilaryngectomy is oncologically sound and can circumvent many of the quality-of-life issues seen with total laryngectomy. The problem is, hemilaryngectomy has fallen out of favor to some degree with many surgeons due to the difficulty of achieving good laryngeal function after surgery.”
Part of the reason for this, he said, is that it’s difficult to recreate the patient-specific anatomy of the larynx, that multiple revisions might be needed for proper function, and that even then “sometimes we’re never really able to restore proper laryngeal function for these patients.”
Tissue-Engineered Larynx Replacement
Dr. Lott’s lab is setting out to develop a tissue-engineered larynx replacement that’s specific to the patient, is permanent, and is completely integrated biologically, while also restoring much of the original function. The replacement is able to be implanted in about three weeks.
“We developed a 3D-printed polyethylene scaffold that is somewhat modifiable,” Dr. Lott said. “If you wanted to medialize that vocal fold structure, you can make those modifications in the software.” Polyethylene was used for the scaffold material, he said, because it has a history of use in the head and neck area, is a permanent structure, holds its shape, and can be biointegrated with the patient’s anatomy.
With their first implant, researchers rearranged tissue, using flaps and other methods, to cover the implant. That patient is now four years past implantation and has done well. Photos displayed during the presentation showed nearly symmetrical halves of the larynx, one native and the other reconstructed, with only a small gap posteriorly on the reconstructed side.