Double-stage laryngotracheal reconstruction
A double-stage laryngotracheal reconstruction (also called laryngotracheoplasty or LTR) involves a repair of the narrowed airway, with the tracheostomy tube left in place during the healing process. The tracheostomy tube will be removed once the area of reconstruction has fully healed.
This is a complex surgery that enlarges a narrowed airway by opening a scarred area and placing cartilage grafts in the openings, which widen the diameter of the airway. The grafts may be placed on the anterior (front) or posterior (back) walls of the airway, or in both places. The tracheostomy tube is left in place below the site of the reconstruction. A small, soft stent is placed in the area of the grafts above the tracheostomy tube.
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This surgery can take anywhere from three to six hours and your child leaves the operating room with a tracheostomy tube still in place. One to two weeks later your child will undergo microlaryngoscopy and bronchoscopy with stent removal. During this 30-minute procedure, a small section of the incision is reopened to cut the stitch that holds the stent in place. The stent is removed through the mouth and photos are taken to document the procedure.
The child's hospital stay is approximately eight to 10 days. They will require additional microlaryngoscopies and bronchoscopies in the weeks following the surgery to monitor the airway healing process. These are done as outpatient surgeries, and your child will usually not be admitted to the hospital. The tracheostomy tube will be removed once the area of reconstruction has fully healed.
Single-stage laryngotracheal reconstruction
In a single-stage reconstruction, grafts may be taken from either the anterior ribs or thyroid cartilage of the larynx and placed on the anterior (front) or posterior (back) walls of the airway, or in both places.
This surgery can take three to five hours and your child leaves the operating room with a breathing tube (no tracheostomy). Your child's breathing tube must remain in place for four to seven days to stent the area while it heals.
The total length of the hospital stay will depend on your child's healing process, and is typically two to three weeks in the intensive care unit (ICU).