The length of laryngotracheal reconstruction surgery varies and depends on your or your child's individual situation and what type of procedure is performed. All surgical options for laryngotracheal reconstruction require general anesthesia, so you or your child will be unconscious during the procedure.
Open-airway laryngotracheal reconstruction can be done in one or multiple stages, using different techniques, depending on the severity of your or your child's condition.
Many people undergoing laryngotracheal reconstruction surgery have already undergone a tracheostomy — a surgically inserted tube from the neck directly into the trachea — to help with breathing.
During a single-stage reconstruction:
- A tracheostomy tube, if present, is removed.
- The surgeon widens (reconstructs) the airway by inserting precisely shaped pieces of cartilage (grafts) from the ribs, ear or thyroid into the trachea.
- A temporary tube inserted through the mouth into the trachea (endotracheal tube), is put into place to support the cartilage grafts. The endotracheal tube will typically remain in place from a few days to about two weeks, depending on the amount of time it will take for the area to heal — a factor mostly determined by the amount and position of the cartilage grafts.
During a double or multistage reconstruction:
- The surgeon widens (reconstructs) the airway by inserting precisely shaped pieces of cartilage from the ribs, ear or thyroid into the trachea.
- To provide a framework for the airway to heal, the tracheostomy tube is left in place or a stent (a straight or T-shaped hollow tube) is inserted. The stent remains in place until the area heals — a process that takes about four to six weeks or more — with the intent of removing it during the next stage.
Sometimes, the narrow part of the windpipe is removed completely and the remaining segments are sewn together. This is called a resection.
Endoscopic laryngotracheal reconstruction is a less invasive procedure. During endoscopic surgery, the doctor inserts surgical instruments and a rod fitted with a light and camera through a rigid viewing tube (laryngoscope) into your or your child's mouth and moves them into the airway to perform the surgery. This surgical option may not be recommended if the airway is severely narrowed or scarred.
Your child may need help from a breathing machine (ventilator, or respirator) or may need sedation to help prevent the breathing tube from coming out. How long your child may need sedation or breathing assistance depends on your child's other medical conditions and age.
Most people stay in the hospital seven to14 days after open-airway laryngotracheal reconstruction surgery, although in some cases it may be longer. Endoscopic surgery is performed on an outpatient basis, so you or your child may go home the same day or spend several days in the hospital.
Treatment and recovery after surgery varies depending on what procedure you or your child has. Full recovery may take a few weeks to several months.
In the weeks following surgery, the doctor performs regular endoscopic exams to check the progression of airway healing. Speech therapy may be recommended to help with any voice or swallowing problems.
March 27, 2013
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