Laryngotracheal Reconstruction

There are two ways surgeons can operate on the voice box or windpipe to widen it:

• Endoscopic repair: For mild or limited areas of stenosis, the surgeon reaches the area with a lighted hollow tube called an endoscope inserted into your child’s mouth. Small instruments guided through the endoscope are used to perform the surgery. A balloon may be inserted in the airway and inflated to widen the narrowed area.
• Open repair: For more serious stenosis or stenosis in a larger area, the surgeon may make an opening in your child’s neck or chest to reach the windpipe. 

The reconstruction can happen in one or more procedures:

• Single stage LTR may be a choice if your child has stenosis in a limited area and does not have other heart or lung problems.
• Double stage LTR may be recommended if your child has severe narrowing in different areas of the windpipe, or heart or lung abnormalities. A breathing tube in the neck (tracheostomy) stays in place as the surgical area heals and is removed with another procedure later. 

• Laryngotracheal reconstruction can treat airway narrowing and help your child breathe.
• A successful laryngotracheal reconstruction can help your child avoid the need for a tracheostomy or help remove a previously placed tracheostomy tube.

Risks of laryngotracheal reconstruction include:

• Stenosis coming back
• Scar tissue 
• An abnormal opening (fistula) between the windpipe and the food tube (esophagus) or the skin
• Injury to the nerves of the voice box
• Swallowing problems
• Air pockets in or around the lungs

The doctor will examine your child to see if laryngotracheal reconstruction is the right choice. After a physical examination, the doctor may recommend:

• Imaging studies (CT scan, X-ray)
• Bronchoscopy or laryngoscopy (looking at the airway while your child is asleep under anesthesia)
• Pulmonary function tests

Laryngotracheal reconstruction takes place in a hospital operating room and the procedure itself takes about two hours.

1. Your child is asleep under general anesthesia. 
2. The doctors reach the narrowed area of the windpipe with an endoscope or by making an opening in the front of your child’s neck.
3. The doctor makes a vertical (lengthwise) opening in the front (or front and back) of the airway. 
4. Then, the doctor implants a patch of cartilage in the opening(s) to make the airway wider. The cartilage most often comes from your child’s ribs but in some cases, the team may use cartilage from an ear. 
5. A breathing tube or rigid cylinder called a stent is inserted into the airway to hold it open as the cartilage patch heals. 

• The doctor closes the neck opening and leaves a small drain in place.
• The doctor closes the small opening in your child’s chest where the rib cartilage was removed. A surgical drain stays in the area for a few days. 
• Your child will spend several days in critical care under sedation to let the surgery heal.
• When it is safe for you to care for your child at home, your child will be released from the hospital.
• After the surgical area heals, you return to the doctor.