What Is Laryngotracheal Reconstruction Surgery?
During this procedure the surgeon widens (reconstructs) the airway by inserting precisely shaped pieces of cartilage (grafts) into the trachea, to establish a permanent, stable airway for you to breathe through without the use of a breathing tube
BEFORE LARYNGOTRACHEAL RECONSTRUCTION SURGERY
Many people undergoing Laryngotracheal Surgery have already undergone a Tracheostomy, which is a surgically inserted tube from the neck directly into the trachea, to help with breathing.
Tracheostomy literally means hole inside the trachea or windpipe. Patients may require a tracheotomy for a number of reasons, including:
- Need to be on a ventilator for a prolonged period of time
- Upper Airway Obstruction including certain infections of the tongue and neck
- Bilateral vocal fold immobility
- Subglottic stenosis
- Tracheal stenosis
- Cancers of head, neck, mouth, tongue and larynx
In some cases, one or more of the following surgeries may be recommended before performing an Laryngotracheal Reconstruction:
- Removing the adenoids or tonsils (adenoidectomy or tonsillectomy). Sometimes these tissues can become infected and swollen and block the airway.
- Removing tissue in the larynx (Supraglottoplasty). This surgery may be necessary to repair the voice box (larynx) if it has partially collapsed (Laryngomalacia), by removing any tissue obstructing the airway.
- Nissen fundoplication. This treatment for Gastroesophageal Reflux Disease (GERD) helps keep stomach acid from flowing back up into the esophagus, which can cause inflammation and contribute to narrowing of the airway.
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.
Risks
Laryngotracheal Reconstruction is a surgical procedure that carries a risk of side effects, including:
- Infection. Infection at the surgical site is a risk of all surgeries. Contact your doctor immediately if you notice redness, swelling or discharge from an incision or record a fever of 100.4 F (38 C) or higher.
- Collapsed lung (pneumothorax). The partial or complete flattening (collapse) of one or both lungs can result if the lung's outer lining or membrane (pleura) is injured during surgery. This is an uncommon complication.
- Endotracheal tube or stent displacement. During surgery, an endotracheal tube or stent may be put in place to ensure a stable airway while healing takes place. If the endotracheal tube or stent becomes dislodged, complications may arise, such as infection, collapsed lung or subcutaneous emphysema — a condition that occurs when air leaks into chest or neck tissue.
- Voice and swallowing difficulties. You or your child may experience a sore throat or a raspy or breathy voice after the endotracheal tube is removed or as a result of the surgery itself. Speech and language specialists can help manage speaking and swallowing problems post-surgery.
- Anesthesia side effects. Common side effects of anesthesia include sore throat, shivering, sleepiness, dry mouth, nausea and vomiting. These effects are usually short-lived, but could continue for several days.
PRE-SURGERY STUDIES AND TESTS
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, including:
- Endoscopic examination provides a direct view of the airway and allows accurate assessment of the location, length and severity of the airway narrowing. Because of the frequent association of acid reflux, it may be combined with upper gastrointestinal endoscopy to view the esophagus and stomach.
- Pulmonary function tests determine whether your lungs can handle certain airway reconstruction procedures.
- CT scan and MRI tests may be used to further visualize the laryngotracheal anatomy and the lungs.
- Swallowing difficulty (dysphagia) evaluations record the swallowing process as you eat or drink.
- Voice evaluation helps find the cause of vocal problems and helps plan effective treatment.
- PH/impedance probe studies help determine whether acid from the stomach is backing up into the esophagus and airway.
- Sleep studies (polysomnograms) look for disruptions in your sleep pattern caused by the airway.
THE PROCEDURE
LARYNGOTRACHEAL RECONSTRUCTION SURGERY requires general anesthesia and can be performed in one or multiple stages, using different techniques, depending on the severity of your condition.
Your surgeon will carefully evaluate you to determine the safest surgical approach to treat your medical condition:
