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A Voice for Cooper: Le Bonheur Surgeon Builds Airway, Voice Box in Groundbreaking Surgery
Cooper Kilburn was born without an airway and voice box, living with a trachea tube to function. Dr. Jerome Thompson, Professor and Chair of Otolaryngology, Head & Neck Surgery at The University of Tennessee Health Science Center, discusses the groundbreaking surgery performed on Cooper.
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Learn more about Jerome Thompson, MD, MBA
Jerome Thompson, MD, MBA
Jerome Thompson, MD, MBA is a Professor and Chair of Otolaryngology, Head & Neck Surgery, The University of Tennessee Health Science Center.Learn more about Jerome Thompson, MD, MBA
Transcription:
A Voice for Cooper: Le Bonheur Surgeon Builds Airway, Voice Box in Groundbreaking Surgery
Cooper Kilburn was born without an airway and voice box, living with a trachea tube to function. Dr. Jerome Thompson, Professor and Chair of Otolaryngology, Head & Neck Surgery at The University of Tennessee Health Science Center.
Bill Klaproth (Host): I want to share with you a really quick story. Young Cooper is a little boy that was born with no airway. No larynx and therefore, no voice. He relied on a trach tube to breath. He slept on a ventilator to survive the nights and at two years old, he had never made a sound. Not a cry, not even a whimper. And that’s how the story begins. Luckily, for Cooper though, his medical team at Le Bonheur made sure that wasn’t the end. On February 27th, 2019, Cooper became the world’s first recorded child born with no airway or larynx to successfully undergo voice box reconstruction. The surgeon who performed that successful reconstruction is with us now. So, let’s learn more about this groundbreaking surgery with Le Bonheur Otolaryngologist Dr. Jerome Thompson. This is the Peds Pod by le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Thompson, it’s a pleasure to talk with you. So, let’s start here. how did you first come in contact with Cooper and his family at Le Bonheur?
Jerome Thompson, MD, MBA (Guest): Cooper’s family came to Le Bonheur to the high risk maternal fetal service in conjunction with the med and they consulted me because they felt that the child would need an EXIT procedure and that’s a procedure where the child is delivered still attached to the umbilical cord by C-section, kept halfway in the mother’s abdomen so they stay warm and you do a tracheostomy to secure an airway.
Host: So, you performed the EXIT procedure while the baby was still half in his mother’s womb. What was the original diagnosis? How did you know this was happening?
Dr. Thompson: He was born without a voice box. It was accidentally found when he was in a high speed automobile accident at 17 weeks of gestation. An ultrasound showed that he had no fluid column in his airway. And which meant that the trachea was not connected to the back of the throat.
Host: So, without an airway, how did you know that Cooper would survive birth?
Dr. Thompson: Well he wasn’t going to survive unless we did the exit procedure. Because if he had been born in some other setting, they wouldn’t have been able to do an emergency tracheostomy on a tiny, tiny baby in a fast enough method because the only circulation he had was from the umbilical cord. And so, we did it with a really experienced team at Le Bonheur and two ENT doctors, three OB-GYN doctors and neonatal doctors and we had a lot of people in the room to help us.
Host: So, as I mentioned; young Cooper then for the next two years relied on a trach tube to breath, sleeping on a ventilator to survive. And what point then did you decide that total voice box reconstruction was an option for Cooper?
Dr. Thompson: We knew we could not do anything in the form of reconstruction until he was two years of age from our vast experience reconstructing damaged airways from intubation. And so we scoped him numerous times during the two years while we waited to see if there was anything we could do. And one day, while he was under anesthesia; as he was coming out, we saw some movement underneath the surface of the tissues that looked like someone’s legs moving underneath a blanket and that meant that he had vocal cords that might work in the future. And so, right then, I decided I could reconstruct him.
Host: Okay, can you walk us through then, the process of reconstructing Cooper’s airway?
Dr. Thompson: Well first we had imaging that showed us that there was no laryngeal structure and that there was just kind of a solid cylinder like a spool of thread but without a hole in the center of it. it was just a sold cylinder of cartilage. And very much like a piece of wood and so what we did was, we knew we were going to have to get cartilage from someplace, so we took pieces of the lower rib from the lower part of his chest and we had a pediatric surgeon Dr. Ying Zhuge, who harvested those ribs for us. And then, what we did was we carved them in such a way that they had a little lip around the edges. Once we got the cartilages shaped the way we wanted them and we got the chest incisions closed; we then opened up his neck, really not knowing what we were going to find.
We had imaging but the CT imaging is helpful, but it doesn’t tell you what the soft tissues are going to look like. So, then we found this solid cylinder of cartilage that was supposed to have been hollowed out in utero, but it didn’t happen. And so we used telescopes that had done able to rotate the image by 90 degrees so we could see around corners. So, we put telescopes in at the trach site and telescopes in through his mouth and put needles through the what appeared to be the airway so we could find the midline, confirmed the midline and then we connected the two needle incisions, puncture wounds and that told us we were making an incision dead center.
We cut through to the cartilaginous block and it was just solid and so I hollowed out the center of it as much as I could and then I put one of the rib grafts into the esophagus to make a back wall of the larynx and a front wall for the esophagus. Then I put the other one in the front and then I put a plastic cylinder in to hold everything in place.
Host: Simply amazing. So, what is the significance of this reconstruction in the history of airway surgeries?
Dr. Thompson: Well one, we’ve been reconstructing damaged voice boxes for about 40 years using rib grafts. But those are dependent on there having been an airway there before. And there have been attempts to rebuild the voice box, but they failed because there just wasn’t normal tissue in there to work with. And so, what we did, was we had done maybe 100 what we call laryngotracheoplasties where we rebuilt damaged voice boxes with ribs and from that experience, I knew that it wouldn’t be too large of a leap to completely create a larynx when I put the right pieces in place.
Host: So, in a nutshell, how did this reconstruction differ from previous airway reconstruction surgeries?
Dr. Thompson: There was no airway to follow. We simply kind of created a path rather than having a natural path to follow.
Host: So, tell us, how is Cooper doing now?
Dr. Thompson: He’s doing very well. We have a photograph of him blowing on one of those New Year’s Eve toys where it unroll in front of you. And so, we know that he’s open and he can breathe through it. We don’t have a voice. He’s making some sounds. We will continue to revise him and try to get him bigger. Now that we’ve gotten an opening; we want to make it bigger because as we know, that it may or may not grow with him. We’re not sure yet. It’s really never been done before. And so we’ll monitor him every six months and revise him as necessary.
Host: Right. So, what is your hope for Cooper’s future? Do you hope that someday he will be able to speak?
Dr. Thompson: Well, I know he’s going to be able to speak. I don’t know if we’ll ever be able to get rid of the trach tube. The hope is that we can. If I build it too wide open, then his saliva will go down in his lungs and that would be a problem. If I build it just right, where he can close it; then we are safe and maybe someday can take the trach tube out. We just got to test it and show that his lungs are fully developed now. They were terribly compromised because the normal lungs make fluid that circulates and that you swallow while you are in the womb. His lungs were severely damaged by the lack of a pathway for the pulmonary and the lung fluid to exit and so it took three almost four years for his lungs to mature.
Host: Wo, you’ve given this young boy an incredible gift. This is amazing what you’ve done for him. So, and thank you so much for explaining this to us. It’s just amazing what you are able to do at Le Bonheur. Dr. Thompson, thank you so much for your time today. we really appreciate it.
Dr. Thompson: You’re very welcome. Thank you.
Host: That’s Dr. Jerome Thompson an Otolaryngologist at Le Bonheur Children’s Hospital. And to read more about Cooper’s story and Dr. Thompson’s process of rebuilding an airway from scratch, please visit www.lebonheur.org/promise, that’s www.lebonheur.org/promise. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening. nter, discusses the groundbreaking surgery performed on Cooper.
A Voice for Cooper: Le Bonheur Surgeon Builds Airway, Voice Box in Groundbreaking Surgery
Cooper Kilburn was born without an airway and voice box, living with a trachea tube to function. Dr. Jerome Thompson, Professor and Chair of Otolaryngology, Head & Neck Surgery at The University of Tennessee Health Science Center.
Bill Klaproth (Host): I want to share with you a really quick story. Young Cooper is a little boy that was born with no airway. No larynx and therefore, no voice. He relied on a trach tube to breath. He slept on a ventilator to survive the nights and at two years old, he had never made a sound. Not a cry, not even a whimper. And that’s how the story begins. Luckily, for Cooper though, his medical team at Le Bonheur made sure that wasn’t the end. On February 27th, 2019, Cooper became the world’s first recorded child born with no airway or larynx to successfully undergo voice box reconstruction. The surgeon who performed that successful reconstruction is with us now. So, let’s learn more about this groundbreaking surgery with Le Bonheur Otolaryngologist Dr. Jerome Thompson. This is the Peds Pod by le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Thompson, it’s a pleasure to talk with you. So, let’s start here. how did you first come in contact with Cooper and his family at Le Bonheur?
Jerome Thompson, MD, MBA (Guest): Cooper’s family came to Le Bonheur to the high risk maternal fetal service in conjunction with the med and they consulted me because they felt that the child would need an EXIT procedure and that’s a procedure where the child is delivered still attached to the umbilical cord by C-section, kept halfway in the mother’s abdomen so they stay warm and you do a tracheostomy to secure an airway.
Host: So, you performed the EXIT procedure while the baby was still half in his mother’s womb. What was the original diagnosis? How did you know this was happening?
Dr. Thompson: He was born without a voice box. It was accidentally found when he was in a high speed automobile accident at 17 weeks of gestation. An ultrasound showed that he had no fluid column in his airway. And which meant that the trachea was not connected to the back of the throat.
Host: So, without an airway, how did you know that Cooper would survive birth?
Dr. Thompson: Well he wasn’t going to survive unless we did the exit procedure. Because if he had been born in some other setting, they wouldn’t have been able to do an emergency tracheostomy on a tiny, tiny baby in a fast enough method because the only circulation he had was from the umbilical cord. And so, we did it with a really experienced team at Le Bonheur and two ENT doctors, three OB-GYN doctors and neonatal doctors and we had a lot of people in the room to help us.
Host: So, as I mentioned; young Cooper then for the next two years relied on a trach tube to breath, sleeping on a ventilator to survive. And what point then did you decide that total voice box reconstruction was an option for Cooper?
Dr. Thompson: We knew we could not do anything in the form of reconstruction until he was two years of age from our vast experience reconstructing damaged airways from intubation. And so we scoped him numerous times during the two years while we waited to see if there was anything we could do. And one day, while he was under anesthesia; as he was coming out, we saw some movement underneath the surface of the tissues that looked like someone’s legs moving underneath a blanket and that meant that he had vocal cords that might work in the future. And so, right then, I decided I could reconstruct him.
Host: Okay, can you walk us through then, the process of reconstructing Cooper’s airway?
Dr. Thompson: Well first we had imaging that showed us that there was no laryngeal structure and that there was just kind of a solid cylinder like a spool of thread but without a hole in the center of it. it was just a sold cylinder of cartilage. And very much like a piece of wood and so what we did was, we knew we were going to have to get cartilage from someplace, so we took pieces of the lower rib from the lower part of his chest and we had a pediatric surgeon Dr. Ying Zhuge, who harvested those ribs for us. And then, what we did was we carved them in such a way that they had a little lip around the edges. Once we got the cartilages shaped the way we wanted them and we got the chest incisions closed; we then opened up his neck, really not knowing what we were going to find.
We had imaging but the CT imaging is helpful, but it doesn’t tell you what the soft tissues are going to look like. So, then we found this solid cylinder of cartilage that was supposed to have been hollowed out in utero, but it didn’t happen. And so we used telescopes that had done able to rotate the image by 90 degrees so we could see around corners. So, we put telescopes in at the trach site and telescopes in through his mouth and put needles through the what appeared to be the airway so we could find the midline, confirmed the midline and then we connected the two needle incisions, puncture wounds and that told us we were making an incision dead center.
We cut through to the cartilaginous block and it was just solid and so I hollowed out the center of it as much as I could and then I put one of the rib grafts into the esophagus to make a back wall of the larynx and a front wall for the esophagus. Then I put the other one in the front and then I put a plastic cylinder in to hold everything in place.
Host: Simply amazing. So, what is the significance of this reconstruction in the history of airway surgeries?
Dr. Thompson: Well one, we’ve been reconstructing damaged voice boxes for about 40 years using rib grafts. But those are dependent on there having been an airway there before. And there have been attempts to rebuild the voice box, but they failed because there just wasn’t normal tissue in there to work with. And so, what we did, was we had done maybe 100 what we call laryngotracheoplasties where we rebuilt damaged voice boxes with ribs and from that experience, I knew that it wouldn’t be too large of a leap to completely create a larynx when I put the right pieces in place.
Host: So, in a nutshell, how did this reconstruction differ from previous airway reconstruction surgeries?
Dr. Thompson: There was no airway to follow. We simply kind of created a path rather than having a natural path to follow.
Host: So, tell us, how is Cooper doing now?
Dr. Thompson: He’s doing very well. We have a photograph of him blowing on one of those New Year’s Eve toys where it unroll in front of you. And so, we know that he’s open and he can breathe through it. We don’t have a voice. He’s making some sounds. We will continue to revise him and try to get him bigger. Now that we’ve gotten an opening; we want to make it bigger because as we know, that it may or may not grow with him. We’re not sure yet. It’s really never been done before. And so we’ll monitor him every six months and revise him as necessary.
Host: Right. So, what is your hope for Cooper’s future? Do you hope that someday he will be able to speak?
Dr. Thompson: Well, I know he’s going to be able to speak. I don’t know if we’ll ever be able to get rid of the trach tube. The hope is that we can. If I build it too wide open, then his saliva will go down in his lungs and that would be a problem. If I build it just right, where he can close it; then we are safe and maybe someday can take the trach tube out. We just got to test it and show that his lungs are fully developed now. They were terribly compromised because the normal lungs make fluid that circulates and that you swallow while you are in the womb. His lungs were severely damaged by the lack of a pathway for the pulmonary and the lung fluid to exit and so it took three almost four years for his lungs to mature.
Host: Wo, you’ve given this young boy an incredible gift. This is amazing what you’ve done for him. So, and thank you so much for explaining this to us. It’s just amazing what you are able to do at Le Bonheur. Dr. Thompson, thank you so much for your time today. we really appreciate it.
Dr. Thompson: You’re very welcome. Thank you.
Host: That’s Dr. Jerome Thompson an Otolaryngologist at Le Bonheur Children’s Hospital. And to read more about Cooper’s story and Dr. Thompson’s process of rebuilding an airway from scratch, please visit www.lebonheur.org/promise, that’s www.lebonheur.org/promise. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening. nter, discusses the groundbreaking surgery performed on Cooper.