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Medical College of Georgia surgeons restore woman's voice

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Nicole Reed jokes that she is thinking about going on a speaker’s tour.

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Dr. Paul Weinberger talks about the reconstructive surgery he performed on Nicole Reed to restore her voice. Doctors used rib cartilage to reconstruct Reed's trachea.  ZACH BOYDEN-HOLMES/STAFF
Dr. Paul Weinberger talks about the reconstructive surgery he performed on Nicole Reed to restore her voice. Doctors used rib cartilage to reconstruct Reed's trachea.

“I have a lot to say because it has been a struggle,” the 27-year-old Mil­ledgeville woman said.

After more than four years without a voice, Reed can finally talk again.

When a terrible car accident and long recovery left her with a tracheotomy and scar tissue that took over her windpipe, Reed received a series of surgeries at Medical College of Georgia Hospital and Clinics that rebuilt her trachea, removed the scar tissue and reversed the tracheotomy, allowing her to speak again.

The surgery, which Dr. Paul Wein­berger learned in London at the Royal Na­tional Throat Nose and Ear Hos­pital, might be the first to be performed in the United States. Now Wein­berger, an assistant professor and the director of research in the Department of Otolaryngology, is working on a way to grow cartilage in the lab to help prevent some of the painful side effects from it.

Reed was driving March 30, 2008, when her car went off the road, flipped and threw her. Police went to her parents’ house and told them she was dead, said her mother, Tammy.

“While the officers were still there, they said they got her back,” she said.

Reed had to be revived again on the way to the hospital in Macon. She was in a coma for more than a month and had to be intubated because she couldn’t breathe on her own. The tube, and the scar tissue that formed around it, became the problem.

Reed has an unusually small trachea and the tube likely was the wrong size, though it did save her life and was properly done by the EMTs, Weinberger said. As the scar tissue built up, it eventually overwhelmed her trachea. That and the tracheotomy prevented Reed from talking for years.

Weinberger and Dr. Gregory Post­ma, the director of MCG’s Center for Voice and Swallowing Dis­­or­ders, decided to try to rebuild the trachea in a technique used in Europe but, to their knowledge, not yet tried in the United States.

They took rib cartilage from Reed, shaped it into a flap and attached it to a muscle in the neck so it could grow its own blood supply. After a couple of months, they went in to clear out all of the scar tissue that had built up in her windpipe above the trachea.

“(With) a lot of people you’ll have a little opening or something to work with,” Wein­ber­ger said. “She had just total collapse. When we went in and cored that out, you’re basically left almost with a half-pipe where the scar tissue was. Then we took cartilage flap and laid it on top, and that forms the new airway.”

Basically, they turned the flap around over the opening to complete the pipe.

There have been other methods used to rebuild trachea, including using mesh under the skin, Weinberger said.

The procedure is not without drawbacks from the harvesting of skin and cartilage from the patient.

“She had two different grafts, and they’re both pretty painful,” Weinberger said. He is working on a potential way around that in the future that might use small amounts of tissue harvested from the patient’s mouth or airway.

“We are working in the lab right now on ways to grow these cells” into cartilage and skin, Weinberger said.

As it stands, the new technique could potentially offer a solution for someone who has a permanent tracheotomy.

“I don’t think anybody really knows” how many people that is, Weinberger said. “Because there are so many patients that have a trach, have been told this is just the way it is going to be, and don’t know that maybe that is not true.”

As the surgery is refined and word gets out, that could change, Postma said.

“Paul’s work here is amazing,” he said. “There are hundreds and hundreds of people, if not thousands, that can benefit from this.”

For Reed, not being able to talk was frustrating in many ways.

“Just not being able to interact with anybody,” she said. For instance, “I couldn’t go to the drive-through and order food.”

As work has shifted from manual labor to being heavily dependent on telecommunications, not being able to talk is a serious deficit, Weinberger said.

“Our society is so voice- and communication-driven that if you don’t have a voice, you can’t work,” he said.

“It’s a bigger disability than not having a limb,” Postma said.

Within weeks of her surgery, Reed was talking again. She has talked so much since then that she can’t remember the first things she said, just the relief at finally having her voice back.

“I think I was smiling and laughing more than anything,” Reed said. “My mother said I was talking to myself one night just to hear myself talk.”

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MD2013 09/02/12 - 08:31 pm
Simply amazing

I can still remember Dr. Weinberger lecturing to our medical school class when he had just returned from London on his fellowship. Amazing educator and an inspiration to the training physicians that are around him. One of the most gifted surgeons in the area and the most humble as well.

Great job!

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