Laryngotracheal Reconstruction

Overview

Laryngotracheal reconstruction surgery

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Mayo Clinic is one of the few medical centers in the United States with the surgical expertise in pediatric otolaryngology (ear, nose and throat medicine) to perform laryngotracheal reconstruction surgery. This type of surgery is done to widen a narrowed windpipe that has created breathing difficulty for a child. The procedure involves removing a small piece of cartilage from the ribs, thyroid gland or ear. That cartilage is placed in the narrowed part of the airway to widen it permanently.

For children undergoing laryngotracheal reconstruction, Mayo Clinic provides world-class care in a comfortable and caring environment, specifically designed for a child's special needs. Mayo doctors know the importance that parents and other caregivers place on restoring a child's health and quality of life after an illness. Children also benefit from the extensive training of the Mayo surgical team, which offers individualized and innovative surgical treatment techniques and variations to meet each child's reconstruction needs.

The size of the Mayo Clinic Pediatric Otolaryngology practice in Minnesota allows the experienced teams of physicians and medical staff to collaborate among themselves and to develop an ongoing relationship with patients and families. Physicians and staff understand the special needs of pediatric patients and their families and are personally available to discuss a family's concerns.

Evaluation

Mayo Clinic physicians perform a thorough evaluation prior to laryngotracheal reconstruction surgery. Specialists in Pediatric Otolaryngology, Speech Therapy, Respiratory Therapy, Pediatrics, Pulmonary Medicine and Radiology can collaborate to assess each patient's needs. To achieve a successful surgical outcome, medical staff answer questions in detail and actively address and manage all other conditions that may be contributing to a child's breathing problems.

A child's windpipe can become narrow for many reasons including injury, infection, stomach acid reflux, a birth defect, or the insertion of a breathing tube. During the evaluation, tiny telescopes with cameras (fiberoptic and rigid laryngoscopy and bronchoscopy) are gently moved through the airway to identify all narrowed sites. X-rays of the neck are taken to view the structure and shape of the airway.

Surgical Options

Some children have severely narrowed airways, and a tracheostomy (trach) breathing tube may need to be placed in the windpipe (trachea) to create an artificial airway prior to laryngotracheal reconstruction. The tube extends upward in the airway and out through a surgically created opening (tracheotomy) in the patient's neck.

Laryngotracheal reconstruction can be done in one or multiple stages. Single-stage reconstruction involves removing a trach tube, if present, and reconstructing the airway. Double or multistage reconstruction involves removing the tube in a subsequent procedure after initial surgery to widen the windpipe.

During laryngotracheal reconstruction surgery, the surgeon inserts precisely shaped pieces of cartilage from the ribs, ear or thyroid gland into the airway to widen the narrow areas. The procedure usually lasts a few hours.

A breathing tube (stent) is temporarily placed through the nose post-surgery to hold the airway and new cartilage in place while the throat heals. The patient may have a drain at the wound site in the neck for one to two days after surgery to drain body fluids. Recovery may last for a few weeks to a few months depending on the child's condition and the type of surgery.

Surgery is followed by periodic, careful review of the airway through a series of exams using small telescopes with a camera (microlaryngoscopy and bronchoscopy) to check the progression of airway healing. Some children may experience a change in the strength and quality of their voice after surgery, which can be improved with speech therapy.