Larynx transplantation and artificial larynx: history and possible perspectives

INTRODUCTION: Laryngeal cancer continues to pose significant challenges. Total laryngectomy (TL) is the standard treatment for advanced stage laryngeal cancer for patients not amenable to organ preservation regimens. Although TL often offers the best chances for cure, the consequences are a permanent tracheostoma and the loss of native voice. EVIDENCE ACQUISITION: We present a systematic review of the current state of the artificial larynx, with a brief excursus from past attempts to new proposals. EVIDENCE SYNTHESIS: The use of human larynx transplantation remains a very limited option because of the reinnervation and consequently the control of the respiratory space such that persistent tracheotomy is required in all cases. Moreover, lifelong immunosuppression, does not allow its use for cancers of the larynx. Soft robotics, focusing on flexible materials resembling biological matter, has paved the way for soft active implants like an artificial larynx. CONCLUSIONS: The present review shows the main developments on the artificial larynx from the first transplant attempts to the latest discoveries in bioengineering and robotics. Future perspectives include improving the design of structures ensure the integrated performance of all key functions of the larynx (breathing phonation and sphincter function).