What is Laryngotracheal Reconstruction?

 

Laryngotracheal reconstruction is a procedure in which the airway is made larger by placing a graft in the area that is narrowed. Most grafts are made of ear cartilage, thyroid cartilage, or rib cartilage. The ENT doctor will decide what type of graft is best for your child. 

The ENT doctor will also decide where the graft needs to placed: in the front of the airway (also called anterior), the back of the airway (also called posterior), or both in order to make the airway larger. 

 

What is Cricotracheal Resection?

 

CTR is a procedure where the narrowed part of the airway is removed and the two adjacent healthy parts of the airway are connected. This procedure is more complicated than a LTR and therefore is reserved for more severe cases.

The main surgery is followed by a series of scopes (or Microlaryngoscopy and Bronchoscopy) in the operating room to check the airway for healing. If your child has a tracheotomy tube, the tracheotomy tube may come out during the surgery and the hole (also known as a stoma) may be closed. There will be an incision in the neck where the surgery was done.

A small drain will be in the neck to allow fluid and air to drain after the surgery. If rib cartilage is used, there will be a small incision on the chest and a drain will be in place after the surgery. The ENT doctor will decide how long the drains will remain in place. A breathing tube (also known as an endotracheal tube or ETT) will be in place through the nose after the surgery.

The breathing tube holds the airway and graft in place while it heals so it does not shrink back down. The ENT doctor will decide how long the breathing tube needs to stay in place.

 

 

What can I expect after my child's surgery?

 

 

Your child will be cared for and closely monitored in the intensive care unit (ICU) after surgery. The ICU doctors will closely monitor your child's total care, while the ENT doctors will closely monitor the airway. While your child is in the ICU, medications may be given to help prevent them from pulling out their breathing tube. These medications make them sleepy and comfortable. 

Before the breathing tube is removed (also called extubation), often children return to the operating room for a microlarynoscopy and bronchoscopy (ML&B) to see how well the airway is healing. The ENT doctor will decide when the breathing tube should be removed. 

Once the breathing tube is removed, your child's breathing will be closely monitored. When the medications that make your child sleepy are stopped, some children experience jitteriness or slight unsteadiness (also called withdrawal) for a short period of time. 

The ENT doctor will decide when the next microlaryngoscopy and bronchoscopy is needed, usually before discharge. Once breathing is stable, the child will be transferred to a high observation unit (also called airway unit) for monitoring. As children continue to progress with breathing on their own, tolerating feedings and healing overall, they will be cared for in the hospital until ready for discharge.