The primary goal of laryngotracheal reconstruction surgery is to establish a permanent, stable airway for you or your child to breathe through without the use of a breathing tube. Surgery can also improve voice and swallowing issues. Reasons for this surgery include:
- Narrowing of the airway (stenosis). Stenosis may be caused by infection, disease or injury, but it's most often due to irritation related to breathing tube insertion (endotracheal intubation) in infants born with congenital conditions or born prematurely or as a result of a medical procedure.
- Malformation of the voice box (larynx). Rarely, the larynx may be incompletely developed at birth (laryngeal cleft) or constricted by abnormal tissue growth (laryngeal web), which may be present at birth or a result of scarring from a medical procedure or infection.
- Weak cartilage (tracheomalacia). This condition occurs when an infant's soft, immature cartilage lacks the stiffness to maintain a clear airway, making it difficult for your child to breath.
- Vocal cord paralysis. Also known as vocal fold paralysis, this voice disorder occurs when one or both of the vocal cords don't open or close properly, leaving the trachea and lungs unprotected. It can be caused by injury, disease, infection or stroke. In many cases, the cause is unknown.
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.
- 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 or your child's lungs can handle certain airway reconstruction procedures.
- CT scan and MRI tests may be used to further visualize the laryngotracheal anatomy.
- Swallowing difficulty (dysphagia) evaluations record the swallowing process as you or your child eats or drinks.
- Voice evaluation helps find the cause of vocal problems and helps plan effective treatment.
- pH 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 or your child's sleep pattern caused by the airway.
Additional surgical procedures
One or more of the following surgeries may be recommended before performing an airway reconstruction:
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- Removing the adenoids or tonsils (adenoidectomy or tonsillectomy). Tonsils are the two round lumps of visible tissue in the back of the throat, while adenoids are higher in the throat behind the nose. 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.
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- Meier JD, et al. Multisystem disease and pediatric laryngotracheal reconstruction. Otolaryngologic Clinics of North America. 2012;45:643.
- Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/vocalparal.aspx. Accessed Dec. 29, 2012.
- Flint PW, et al. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05283-2..X0001-8--TOP&isbn=978-0-323-05283-2&uniqId=230100505-57. Accessed Dec. 30, 2012.
- Q & A: What you should know before surgery. American Society of Anesthesiologists. http://www.lifelinetomodernmedicine.com/What-To-Expect/QA-What-You-Should-Know-Before-Surgery.aspx. Accessed Dec. 30, 2012.
- Lando T, et al. Minimally invasive techniques in laryngotracheal reconstruction. Otolaryngologic Clinics of North America. 2008;41:935.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 4, 2013.
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- Weed HG, et al. Postoperative fever. http://www.uptodate.com/home. March 12, 2013.