A Marine Speaks Again

Lance Corporal Walter Lopata made medical history last week when he sat up in his Boston hospital bed and said,"Hello--how are you?" He probably could have said more, but the doctors wouldn't let him try, lest he damage the delicate needlework in his throat. For Lopata had no larynx or vocal cords. These were removed in October after they had been torn to shreds by fragments from a Viet Cong grenade. What he had was a reconstructed throat, the first of its kind in the U.S. and probably in the world.

Skin Valve. Most patients who lose the larynx are cancer victims. These number about 6,000 a year in the U.S., and more than half of them learn to speak again by swallowing huge gulps of air. When they bring it up, it makes the throat muscles vibrate at a fixed, almost toneless pitch, in what Dr. William W. Montgomery of the Massachusetts Eye and Ear Infirmary calls "an educated burp." Every time Surgeon Montgomery has done a laryngectomy, he has longed for a way to give the patient something better than this burping speech. He saw the results of brave attempts in Japan and by Los Angeles' Dr. Alden Miller. But whenever these patients swallowed anything, they had to press a finger against their throats to close their artificial windpipes, to keep food and fluids out of their lungs.

Dr. Montgomery thought he had figured out a way to get around this, and the young Marine for whom he was called into consultation at Chelsea Naval Hospital was an ideal patient for the first operation. Lopata, 25, was essentially healthy, with no cancerous tissues to hamper healing, and a leg wound that would keep him in the hospital for weeks.

Appropriately, it was on Veterans Day last November that Dr. Montgomery and Navy Surgeon Robert Toohill embarked upon the first stage of restoring his speech. To make sure that Lopata's reconstructed windpipe would not let food into his lungs, they built an artificial valve just below the base of his tongue (see diagram) by cutting into his throat and turning two flaps of skin inward. Lopata had been breathing for a month through a hole lower down in his neck. The surgeons fitted this hole with a tube through which he could breathe, and made another opening above it in preparation for the next phase.

Thigh Flaps. After two months of healing came the crucial second stage. Where almost three inches of windpipe (trachea) was missing above the neck opening, Dr. Montgomery constructed a new windpipe from flaps of skin obtained from vertical cuts down the neck. To cover the gaps left by removal of these flaps, he took still other strips from Lopata's thighs. Into the windpipe opening went a valved silver tube.

The theory is that the muscular action of swallowing will automatically close Lopata's new pharyngeal valve; he will continue to inhale through the silver tube, but when he exhales, the air will go past the closed tube and activate the valve at the top of the windpipe. This will serve as a substitute voice box, and Dr. Montgomery is confident that Lopata's speech will be superior to a "burp."

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