Laryngotracheal 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.
Children most commonly experience problems with a narrowed windpipe. It can occur for many reasons, including injury, infection, stomach acid reflux, a birth defect or 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.
Why laryngotracheal reconstruction surgery is done?
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:
Preparation for a laryngotracheal reconstruction surgery
- Narrowing of the airway (stenosis): Stenosis may be caused by infection, disease or injury, but it's most often due to irritation related to breathing tube insertion (endotracheal intubation) in infants born with congenital conditions or born prematurely or as a result of a medical procedure.
- Malformation of the voice box (larynx): Rarely, the larynx may be incompletely developed at birth (laryngeal cleft) or constricted by abnormal tissue growth (laryngeal web), which may be present at birth or a result of scarring from a medical procedure or infection.
- Weak cartilage (tracheomalacia): This condition occurs when an infant's soft, immature cartilage lacks the stiffness to maintain a clear airway, making it difficult for your child to breath.
- Vocal cord paralysis: Also known as vocal fold paralysis, this voice disorder occurs when one or both of the vocal cords don't open or close properly, leaving the trachea and lungs unprotected. It can be caused by injury, disease, infection or stroke. In many cases, the cause is unknown.
Carefully follow your doctor's directions about how to prepare for surgery:
What can you expect during a laryngotracheal reconstruction surgery?
- Avoid food and drink: Your doctor should tell you what time you or your child need 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 cut-off time, surgery may have to be postponed.
- Bring favourite items from home to comfort your child: If your child is having surgery, favourite 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.
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 or multistage reconstruction:
- A tracheostomy tube, if present, is removed.
- The surgeon widens (reconstructs) the airway by inserting precisely shaped pieces of cartilage (grafts) from the ribs, ear or thyroid into the trachea.
- A temporary tube inserted through the mouth into the trachea (endotracheal tube), is put into place to support the cartilage grafts. The endotracheal tube will typically remain in place from a few days to about two weeks, depending on the amount of time it will take for the area to heal - a factor mostly determined by the amount and position of the cartilage grafts.
What can you expect after a laryngotracheal reconstruction surgery?
- The surgeon widens (reconstructs) the airway by inserting precisely shaped pieces of cartilage from the ribs, ear or thyroid into the trachea.
- To provide a framework for the airway to heal, the tracheostomy tube is left in place or a stent (a straight or T-shaped hollow tube) is inserted. The stent remains in place until the area heals - a process that takes about four to six weeks or more - with the intent of removing it during the next stage.
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 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