New procedure helps reconstruct cricoid cartilage in a cancer patient

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.

Wittenberg sought a second opinion at the University of Michigan Health System, where Douglas Chepeha, M.D., M.S.P.H., offered her an alternative - the option of undergoing a new procedure that, if successful, would allow her to keep her voice.

The technique, detailed online ahead of print publication in The Laryngoscope, 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," says Chepeha, director of microvascular surgery in the Department of Otolaryngology, Head and Neck Surgery, at the U-M 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, or shoulder blade, provides the right combination of attributes, Chepeha explains. 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 says. "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.

"We had to pay a great deal of attention to the muscles and cartilage that were attached to the cricoid," Chepeha says. "We had to carefully detach them, check that we had adequately removed the tumor, and then, once the scapular tip was in position, we had to reattach the muscles and cartilage."

Within just three months, Sherry was able to return to work, her voice intact and her larynx cancer-free.

"My greatest fear was that I wouldn't be able to talk again, to work again," says Wittenberg, 58, of Cement City, Mich. "My husband is a dairy farmer and farming's been very rough these days. I knew we needed my job."

Today, Wittenberg says her breathing has returned to normal and her speech is very close to what it was before the operation.

"The only difference is that my voice doesn't have quite the same volume it did before," she says.

"I feel like it was a miracle," Wittenberg adds. "I happened to be in the right place with the right surgeon at the right time who was willing to try something that had never been done."