Laryngotracheal (luh-ring-go-TRAY-key-ul) reconstruction surgery widens your windpipe (trachea) to make breathing easier. Laryngotracheal reconstruction involves inserting a small piece of cartilage — stiff connective tissue found in many areas of your body — into the narrowed section of the windpipe to make it wider.
Children most commonly experience problems with a narrowed windpipe, although the problem can also occur in adults. It can occur for many reasons, including injury, infection, stomach acid reflux, a birth defect or as the result of the insertion of a breathing tube. An adult's windpipe can become narrowed for the same reasons, but the cause may also be a disease that causes blood vessel or tissue inflammation, such as Wegener's granulomatosis or sarcoidosis.
The goal of laryngotracheal reconstruction is to provide a safe and stable airway without the use of assistance from a breathing tube. In people who already have a tracheostomy tube to help them breathe, this procedure often makes it possible to get rid of the tracheostomy.
The primary goal of laryngotracheal reconstruction surgery is to establish a permanent, stable airway for you or your child to breathe through without the use of a breathing tube. Surgery can also improve voice and swallowing issues. Reasons for this surgery include:
Laryngotracheal reconstruction is a surgical procedure that carries a risk of side effects, including:
Carefully follow your doctor's directions about how to prepare for surgery.
If your child is having surgery, favorite items from home such as a stuffed animal, blanket or photos displayed in the hospital room may help comfort your child. This can help smooth the recovery process.
Your doctor should tell you what time you or your child needs to stop eating and drinking in the hours before surgery. Having food or drink before surgery could lead to complications during surgery, such as inhaling partially digested food into the lungs (aspiration). Young children are generally scheduled for morning surgery. If you or your child eats or drinks after the requested cutoff time, surgery may have to be postponed.
Laryngotracheal reconstruction surgery may be performed using several different techniques:
Endoscopic and single-stage open-airway surgeries are generally recommended for mild cases of stenosis, when your or your child's airway isn't severely narrowed.
For more-severe cases of stenosis or if you have medical conditions that may complicate surgery — such as heart, lung or neurological conditions — the doctor may recommend a slower, more conservative approach and perform multiple-stage open-airway reconstruction, which involves a series of procedures over the span of a few weeks to several years.
After taking into consideration your or your child's condition and any other medical issues, the doctor will discuss the most appropriate course of action.
A number of studies or tests are often necessary before laryngotracheal reconstruction surgery. The goal of each study or test is to help evaluate medical conditions that may cause problems with the airway or affect the surgical plan and to prepare for individual follow-up care.
One or more of the following surgeries may be recommended before performing an airway reconstruction:
Open-airway laryngotracheal reconstruction can be done in one or multiple stages, using different techniques, depending on the severity of your or your child's condition.
Many people undergoing laryngotracheal reconstruction surgery have already undergone a tracheostomy — a surgically inserted tube from the neck directly into the trachea — to help with breathing.
During a single-stage reconstruction:
During a double-stage reconstruction:
Sometimes, the narrow part of the windpipe is removed completely and the remaining segments are sewn together. This is called a resection.
In 2013, surgeons developed a third option called hybrid, or one-and-a-half-stage reconstruction, that combines aspects of both single-stage and double-stage reconstruction. With this technique, a single long stent is placed in the existing tracheostomy tube, and a smaller stent is placed through an opening in the trachea (tracheostoma) to provide a secure, secondary airway during and after the procedure.
Endoscopic laryngotracheal reconstruction is a less invasive procedure. During endoscopic surgery, the doctor inserts surgical instruments and a rod fitted with a light and camera through a rigid viewing tube (laryngoscope) into your or your child's mouth and moves them into the airway to perform the surgery, without making any external incisions.
In some cases, your surgeon may use this approach to place the grafts for laryngotracheoplasty. In other cases, your surgeon may be able to use lasers, balloons or other methods to relieve the narrowing endoscopically without needing to do a full laryngotracheoplasty. This surgical option may not be recommended if the airway is severely narrowed or scarred.
Your child may need help from a breathing machine (ventilator, or respirator) or may need sedation to help prevent the breathing tube from coming out. How long your child may need sedation or breathing assistance depends on your child's other medical conditions and age.
Most people stay in the hospital seven to 14 days after open-airway laryngotracheal reconstruction surgery, although in some cases it may be longer. Endoscopic surgery is sometimes performed on an outpatient basis, so you or your child may go home the same day or spend several days in the hospital.
Treatment and recovery after surgery varies depending on what procedure you or your child has. Full recovery may take a few weeks to several months.
In the weeks following surgery, the doctor performs regular endoscopic exams to check the progression of airway healing. Speech therapy may be recommended to help with any voice or swallowing problems.