{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:18:21Z","timestamp":1787843901898,"version":"build-2784847793"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Laryngeal transplantation offers the potential for patients to regain vocal function, yet standardised voice rehabilitation protocols are lacking. We share the experience of our team in the regular follow\u2010up of voice function evaluation and address this gap by establishing a multidisciplinary pathway for functional recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four male transplant recipients (3 laryngeal cancers, 1 hypopharyngeal cancer) underwent protocolized assessments at 1\/3\/6\/8 months post\u2010op: subjective assessment (GRBAS scale) and objective evaluation (multiparametric acoustic analysis and electronic laryngoscopy). Personalized rehabilitation was delivered weekly by a licensed speech therapist. Protocol evolution occurred: Patients 1\u20132 received conventional training; Patients 3\u20134 received intensive neuromuscular reinnervation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The voice of the four patients showed a gradual decrease in the degree of hoarseness, a gradual alleviation of breathiness, and a gradual decrease in asthenia score, with the overall condition improving. The MPT was about 1.8\u00a0s at 1 month after surgery which kept increasing in all patients. The 3rd patient, who performed the best among the 4 patients, had an MPT of more than 10 s at 8 months after surgery. Laryngeal mucosa sensory function was gradually established in patients starting 3 months after operation, and compensatory vibration of ventricular band appeared at 8 months after operation with the assistance of voice training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study anchored to neuromuscular reinnervation milestones demonstrates that standardised evaluations coupled with individualized training progressively restore vocal function. Our protocolized framework guides evidence\u2010based rehabilitation for institutions pursuing laryngeal transplantation<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>WHAT THIS PAPER ADDS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>What is already known on this subject<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Laryngeal transplantation surgically restores laryngeal anatomy but faces functional recovery challenges due to delayed neuromuscular reinnervation. Existing literature focuses predominantly on immunosuppression and graft viability, with sparse evidence guiding postoperative voice rehabilitation. Standardised protocols for phonatory recovery\u2014routine in other neurogenic voice disorders (e.g., vocal fold paralysis)\u2014are absent. Fewer than 20 human cases have been reported globally, and only two publications detail voice outcomes. Consequently, rehabilitation strategies remain ad hoc, lacking consensus on intervention timing, exercise biomarkers, or psychological support frameworks.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What this study adds to existing knowledge<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This study establishes the first protocolized voice rehabilitation framework for laryngeal transplantation, anchored to neuromuscular milestones: Pharyngeal reflex recovery (3 months) signalling sensory reinnervation; Ventricular band compensation (8 months) indicating motor adaptation. We demonstrate that early, structured rehabilitation (initiated at 1 month) enables significant voice restoration (MPT: 1.8\u00a0s \u2192 &gt;10\u00a0s). Critically, we identify modular design principles accommodating clinical interruptions (e.g., ICU admissions) without compromising core outcomes. We anticipate these findings will guide evidence\u2010based rehabilitation for institutions pursuing laryngeal transplantation and inform standardised pathways for complex laryngologic rehabilitation.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What are the potential or actual clinical implications of this work?<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Rehabilitation Standardization<\/jats:bold>\n                            : Provides evidence\u2010based timelines (1\/3\/6\/8\u2010month assessments) and neuromuscular biomarkers to guide intervention intensity.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Broad Applicability<\/jats:bold>\n                            : The protocol shows cross\u2010utility for bilateral vocal fold paralysis and post\u2010traumatic neurogenic dysphonia, leveraging shared reinnervation mechanisms.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Contingency Management<\/jats:bold>\n                            : Modular training design maintains efficacy despite clinical interruptions (e.g., 40% cohort ICU\/oncology transfers).\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Technology Integration<\/jats:bold>\n                            : Validates objective metrics (MPT, mucosal wave symmetry) as targets for future AI\u2010assisted biofeedback tools.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Clinicians should prioritise early sensorimotor retraining (&lt;3 months) while monitoring compensatory strategies (ventricular vibration) as functional proxies.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1460-6984.70228","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T04:45:18Z","timestamp":1774586718000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Functional Voice Restoration After Laryngeal Transplantation: A Multidisciplinary Protocol and Longitudinal Outcomes"],"prefix":"10.1111","volume":"61","author":[{"given":"Bin","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\/Head and Neck Surgery West China Hospital of Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1860-3841","authenticated-orcid":false,"given":"Hailing","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\/Head and Neck Surgery West China Hospital of Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7160-4512","authenticated-orcid":false,"given":"Zheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\/Head and Neck Surgery West China Hospital of Sichuan University  Chengdu Sichuan 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