What is tracheal reconstruction surgery?

Laryngotracheal reconstruction surgery aims to restore the natural breathing in infants or people who rely on an artificial breathing tube. Natural breathing may be hampered due to:

• Narrowing of the airway (stenosis). Stenosis can occur due to:
  • Breathing tube insertion (endotracheal intubation) in infants
  • Infection
  • Disease
  • Injury
• Malformation of the voice box (larynx). There may be incomplete development of the larynx while the baby is in the uterus.
• Weak, soft cartilage (tracheomalacia). A normal trachea is stiff enough to maintain the airway. Tracheomalacia is a condition that is mostly seen in infants.

The doctor will evaluate you to decide what type of surgery will be the most appropriate for you.

There are two ways in which doctors perform laryngotracheal reconstruction surgery. These are:

• Endoscopic surgery: It involves inserting a long tube-like camera and other surgical instruments through your mouth to reconstruct the airway. This method ensures lesser post-operation hospital stay.
• Open airway surgery: The doctor performs the surgery by making an incision in your neck and rebuilding your airway. The surgery may be coupled with other surgeries as and when required.

Pre-surgery studies and tests

A few tests may be conducted before the surgery. These include:

• Endoscopic examination of the airway
• Pulmonary function tests
• Computed tomography or CT scan and magnetic resonance imaging or MRI
• Swallowing difficulty (dysphagia) evaluations
• Voice evaluation
• Impedance probe studies
• Sleep studies (polysomnograms)

You will be sedated and put on an artificial breathing machine known as a ventilator.

If you had open airway laryngotracheal reconstruction surgery, you would have to stay in the hospital for 7-14 days to recuperate. In the case of endoscopic surgery, you may be discharged earlier.

You will be asked to follow-up after a few weeks so that the doctor can check the healing of the surgical area. You may also need speech therapy sessions as advised by your surgeon.

You may take anywhere between a few weeks to several months to recover from the surgery. It depends on what kind of surgery you had and what other medical conditions you have.

Every surgery carries risks. Laryngotracheal surgery is no exception to this. Its possible risks include:

• Wound Infection: The signs of infection include redness, swelling, or discharge at the surgical site, or a fever of 100.4° F or higher. If you notice any of these signs, call your doctor.
• Anesthesia side effects: These usually last for a few days. The common ones include low blood pressure, sore throat, dry mouth, chills, sleepiness, nausea, and vomiting.
• Collapsed lung (pneumothorax): Injury to the lung may result in pneumothorax.
• Difficulty in speaking (dysarthria) and swallowing (dysphagia): Speech therapists can help manage these side-effects of the surgery.