Laryngotracheal Reconstruction Surgery

About

A child's windpipe can become narrowed for many reasons, including injury, infection, stomach acid reflux, a birth defect or the insertion of a breathing tube. Narrowing in the upper part of the windpipe is called subglottic stenosis.

An adult's windpipe can become narrowed for the same reasons as a child's. But the cause is more likely to be other diseases, such as Wegener's granulomatosis.

The primary goal of laryngotracheal reconstruction surgery is to establish and maintain a safe and stable airway. Improving voice and swallowing functions also are important goals, which depend on other medical conditions coexisting with windpipe narrowing.

Evaluation

Mayo Clinic physicians perform a thorough evaluation prior to laryngotracheal reconstruction surgery. Specialists in ENT, gastroenterology, pulmonary medicine, surgery, speech therapy and other areas work together to understand the problem and to identify and manage other conditions that may be contributing to breathing problems.

The doctor will insert a tiny tube with a camera attached (endoscope) through the mouth or nose and gently move it through the airway to identify all narrowed sites. X-rays of the neck are taken to view the structure and shape of the airway. Many other tests may be needed for a complete evaluation, including:

• Swallowing (dysphagia) evaluations
• Voice evaluation
• Endoscopic exam — an endoscopic examination of the esophagus, stomach and first portion of the small intestine (duodenum)
• pH probe studies — tests to learn whether acid from the stomach is "backing up" into the esophagus and airway
• Sleep study (polysomnogram)
• Infection screenings — tests to determine whether an infection is affecting how well the airway heals after surgery

Other surgical procedures

One or more of the following surgeries may be recommended before performing an airway reconstruction:

• Adenoidectomy and tonsillectomy. These tissues can become infected and swollen and block the airway.
• Supraglottoplasty. This surgery may be necessary to repair the voice box (larynx) if it has partially collapsed (laryngomalacia).
• Tongue-base surgery. Extra tissue may be removed if it's obstructing the airway.
• Nissen fundoplication. This treatment for gastroesophageal reflux disease helps keep stomach acid from flowing back up into the esophagus.

Laryngotracheal reconstruction surgery

Laryngotracheal reconstruction can be done in one or multiple stages. The surgeon will discuss which approach is most appropriate.

• Single-stage reconstruction involves removing a tracheostomy 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 into the windpipe to widen the airway. The procedure usually lasts a few hours.

Sometimes, the narrow part of the windpipe is removed completely and the remaining segments are sewn together. This is called a resection.

Endoscopic option

Mayo Clinic has the capability to do laryngotracheal reconstructions endoscopically — that is, through the mouth and airway, without an incision in the skin. This less invasive procedure is usually done on an outpatient basis, so an overnight stay in the hospital isn't needed.

After surgery

In single-stage reconstruction, a breathing tube (stent) is temporarily placed through the nose after surgery to hold the airway and new cartilage in place while the throat heals. A drain may be placed at the wound site in the neck for one or two days after surgery to drain body fluids. Full recovery may take a few weeks to a few months.

If double or multistage reconstruction is done, a tracheostomy tube is left in place after the reconstruction and typically a stent is temporarily placed at the reconstruction site until the area is healed. The tracheostomy tube is removed in a second procedure.

The doctor will perform regular endoscopic exams to check the progression of airway healing. Some people may experience diminished strength and quality of their voice after surgery, which can be improved with speech therapy.