Airway reconstruction, also called laryngotracheal reconstruction, is a surgery performed to remove an obstruction in the airway (windpipe) or to widen the airway if it has been obstructed. This procedure is most often used to treat a condition called laryngotracheal stenosis, also referred to as airway obstruction. This surgery is most often performed on children who are born with physical abnormalities that obstruct the airway, but is also performed on adults. Airway reconstruction can be performed either through open surgical techniques or using endoscopic techniques.
Why Airway Reconstruction Is Performed
Laryngotracheal stenosis is a condition that results in the windpipe, or the airway, becoming more and more narrow. Obstruction can occur for various reasons, such as:
- Congenital laryngeal stenosis (a physical defect present at birth)
- Laryngotracheal tumor
- Trauma or injury to the windpipe
Obstruction of the airway can cause various health concerns, including:
- Sleep apnea
- Inability to swallow correctly
- Husky or hoarse voice
- Inability to breathe correctly
- Difficulty eating
Airway reconstruction is performed to open the airway, eliminate symptoms associated with a blocked airway, and permanently restore the normal function of the airway.
What to Expect During an Airway Reconstruction Procedure
Airway reconstruction procedures are generally performed using general anesthesia. The type of airway reconstruction surgery performed will depend on the severity of the obstruction. Less severe obstructions may be able to be corrected using endoscopic or minimally invasive techniques. During an endoscopic airway reconstruction, a thin, flexible tube is inserted through the mouth to the location of the obstruction either in the esophagus or trachea. Next, a piece of cartilage grafted from the patient’s ear, rib, or thyroid is placed carefully to permanently widen the airway. There are no incisions made during an endoscopic airway reconstruction procedure.
For individuals who have a more severe obstruction, or who have additional health concerns, an open technique may be required. During an open airway reconstruction procedure, the surgeon makes a small incision over the trachea and widens the airway. Next, a piece of cartilage grafted from the patient’s ear, rib, or thyroid is carefully placed in the airway to widen the passageway and keep it open.
An open airway reconstruction treatment option may require more than one operation. If it is performed in one operation, a tube will be temporarily placed in the mouth and through to the trachea to maintain the stent in place until the airway has healed. If treatment is completed using more than one surgery, a tube or a stent is inserted into the airway and left for up to six weeks until the airway has healed. There is then a second surgery to remove the stent or the tube.
Risks Associated with Airway Reconstruction
The risks associated with airway reconstruction surgery depend on the technique used to perform the operation.
- Difficulty swallowing
- Displacement of the endotracheal tube if it becomes dislodged
- Pneumothorax (collapsed lung)
MedStar Washington Hospital thoracic surgeons are specially trained and highly experienced in the safe and effective management of airway reconstruction surgery.
Benefits of Airway Reconstruction
Airway reconstruction provides patients various benefits, such as:
- Creates an airway that remains open, allowing for the normal and healthy facilitation of breath.
- Provides an alternative treatment to tracheotomy, a procedure in which a hole is surgically created in the trachea to provide an additional hole for breathing.
How to Prepare for Airway Reconstruction
Prior to an airway reconstruction procedure, the surgeon may prescribe a battery of tests to assess the health of the patient and determine the exact cause of airway obstruction in order to carefully plan the surgery. Some of these tests may include:
- Endoscopic examination: Allows physicians to see the airway in order to locate and assess the obstruction.
- Pulmonary function test: Evaluates the integrity of the lungs for surgery.
- Polysomnogram (sleep study): Detects problems with sleeping due to airway obstruction.
- pH/impedance probe study: Determines if stomach acid is flowing back up into the esophagus.
- CT and MRI imaging study: Produces images of the airway that allow physicians to locate and analyze an obstruction.
Prior to surgery, the surgeon will provide clear and detailed instructions for the patient to follow in order to ensure a safe and successful surgery.
Post Airway Reconstruction Treatment
Immediately following surgery, patients may be required to remain in the intensive care unit (ICU) until the airway heals. Typically, patients remain in the hospital for seven to 14 days following surgery. This is because patients must be sedated in order to help keep the stent or tube in place that keeps the airway open as it heals. Recovery time will vary from patient to patient and will be determined based on the severity of the obstruction as well as the complexity of the surgery.
Make an Appointment
For an appointment with a specialist, call 202-877-3627.