Airway Reconstruction

Open airway reconstructions include procedures involving the area from the top of the voice box to the trachea (windpipe) and require a skin incision. These procedures are usually performed when other surgeries have failed. Candidates are patients who have airway narrowing, such as subglottic stenosis, tracheal stenosis or glottic webs.

These surgeries are performed to expand a narrow airway, making your child more comfortable in breathing through his or her mouth. This also allows for decannulation (removal of the tracheostomy tube), if present.

The presence of the tracheostomy tube has many benefits and is often necessary for life, but it also has risks. If the tube comes out, children might “lose” their airway and not be able to breathe. The estimated risk of death in a patient with a tracheostomy is as high as 5% per year.

The tracheostomy tube may also cause scar tissue growth and bleeding in the airway and requires lifetime maintenance. In addition, it requires special equipment at home and can lead to a decreased overall quality of life.

Your child may stay in the intensive care unit (ICU) for three to seven days. During this time, he or she may be intubated (have a breathing tube in their nose) and be under sedation (placed in a sleep state) to prevent movement and possible damage of their new, healing airway. A repeat evaluation of the airway will take place three to seven days after the reconstructive surgery, at which time extubation (removal of the breathing tube) will be done, if possible. Expect an average hospital stay of seven to 14 days.

Rib cartilage is an ideal material for airway reconstructions because it is rigid and big enough, and it has no risk of being rejected since it is taken from your child’s own body. Using rib cartilage will result in a small scar on the chest.

Another possible material is a thyroid ala cartilage graft, which is taken from the Adam’s apple. This is done through the same neck incision used to remove the tracheostomy tube and repair the airway.

Your child will need regular airway evaluations (direct laryngoscopy and bronchoscopy or DLB) after the surgery over a period of a year, on average. These evaluations will be gradually spaced out if the airway is healing well. These appointments are extremely important as not doing so can increase the risk of failure.

As with any surgery, risks of bleeding and infection exist. Specific risks for this surgery include pneumothorax (air trapped around the lungs), failure with the need to re-insert a tracheostomy tube and in extremely rare situations (<1%), death. However, these events rarely occur, and the success rates of these procedures are above 90%.

Having reflux (GERD) under control is very important for the success of the surgery. It is important to keep your child on his or her reflux medication. To make sure this is under control, we might ask your child to visit a gastroenterologist (GI) for an expert opinion before surgery. We also may ask your child to start antibiotics before surgery.

On the day of surgery, if the airway exam shows changes that may weaken the chance of success, we may need to reschedule the reconstruction to a later date. This is done to ensure your child has the best results.