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Airway Reconstruction Surgery:
A guide to the procedure, risks and recovery

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1.What is Airway Reconstruction Surgery?

Airway Reconstruction surgery is also known as laryngotracheal reconstruction surgery. It is a surgery option that is used to widen the narrow windpipe called the trachea. This type of surgery is also recommended by your doctor when something is obstructing your windpipe and it needs to be removed. The purpose of the laryngotracheal reconstruction surgery is to make it easy for you to breathe without the help of tracheotomy or a breathing tube. Airway Reconstruction surgery is often required by children because some are born with physical abnormalities, but adults may need it when their windpipe narrows due to a variety of reasons.

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2.Why is Airway Reconstruction Surgery performed?

The benefit of the Airway Reconstruction surgery is that it clears up and decongests the airway and ensures you can breathe normally without the aid of anything else, such as a tube. Laryngotracheal reconstruction surgery is considered a better option than tracheotomy. A tracheotomy is a medical procedure that requires a hole or opening to be created in your trachea through surgery so that you can breathe without difficulty. The opening is created through the neck and into the windpipe.

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3.Conditions that require Airway Reconstruction Surgery

There are numerous conditions that require Airway Reconstruction surgery. Some of the most common conditions are as follows.

  • Stenosis requires Airway Reconstruction surgery because the airway becomes narrow. Stenosis causes include disease, infection, and injury. An irritation that is associated when a breathing tube is inserted in newborn babies that have congenital conditions is one of the reasons for stenosis. Stenosis can affect the windpipe, vocal cords, or the windpipe below the vocal cords.
  • Tracheomalacia refers to weak cartilage that usually is the case with infants. In this, the immature cartilage of the child is soft and isn’t strong enough to remain stiff so that a clear airway is maintained. This makes it difficult for children to breathe.
  • Vocal cord paralysis might require Airway Reconstruction surgery. In this condition, either or both of the vocal cords are unable to function properly. Sometimes the vocal cords are unable to open which can cause breathing difficulty because the airway is obstructed. Vocal cord paralysis has various causes including stroke and injury.
  • When there is a laryngotracheal tumour then it can cause the airway to become obstructed, thereby blocking proper breathing. This is because the inflammatory tissue can build up in the trachea when it narrows the airway it can cause breathing difficulties.
  • Injury to the windpipe due to an accident can cause problems with the airway and can require Airway Reconstruction surgery. If the neck area has been stabbed or if an object hits the neck then this can cause airway problems too.
  • Inflammatory diseases such as asthma can lead to the inflammation of the airways. This can obstruct air from passing through the airways. Asthma is a respiratory condition that affects breathing by making it difficult for you to breathe. Infections can cause airway conditions too and may require Airway Reconstruction surgery.
  • Reflux disease is one of the common problems that people suffer from. Reflux disease can lead to inflammation which in turn can cause breathing problems to occur. This may require Airway Reconstruction surgery so that you can breathe like you normally do.
  • When the larynx is not formed properly then it can cause airway problems. In some people, this may be the case at birth where the larynx is unable to form completely. This is known as laryngeal cleft. It can happen when tissue grows abnormally and this obstructs the larynx. It can occur due to an infection or scarring from a medical procedure.
  • Wegener’s granulomatosis is now called granulomatosis with polyangiitis. It can cause blood vessel inflammation and this is one of the conditions that require Airway Reconstruction surgery. In this condition, various tissues in the body are inflamed. It particularly affects the kidneys and the respiratory tract. It can affect people of any age and the cause of this condition are unknown.

Apart from these causes, autoimmune diseases and radiation therapy can cause airway obstruction which leads to problems in breathing. Surgery can sometimes lead to airway blockage too which requires Airway Reconstruction surgery.

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4.Types of Airway Reconstruction Surgery

There are two ways in which an Airway Reconstruction surgery can take place; open-airway surgery or endoscopic medical procedure. In open-Airway Reconstruction surgery, an incision is made to perform the surgery. In endoscopic procedure, instruments are inserted through your mouth.

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5.Are You The Right Candidate For Airway Reconstruction Surgery?

You need to speak to your doctor about whether you are the right candidate for Airway Reconstruction surgery, or not. Usually, the two types of reconstruction surgeries are recommended to children or adults, when the stenosis is mild. That is, when the airway is not too narrow then your doctor will recommend the surgery. Your doctor will discuss any other problems that you are dealing with such as other medical issues and if you experience symptoms that may point to other problems. Once he does that he will be able to decide and let you know if you are eligible for Airway Reconstruction surgery.

People who suffer from severe stenosis need to take a different approach. This applies to people who have medical problems that can complicate Airway Reconstruction surgery. Such conditions include conditions that are associated with lung or heart among others. When this is the case, your doctor can recommend that instead of having the Airway Reconstruction surgery once, you have multiple-stage open-airway reconstruction. In this, the medical procedures are divided so that you have them within a span of a few weeks or even years. It depends on your condition and health.

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6.How do I prepare for the procedure?

The Airway Reconstruction surgery preparation will be explained by your doctor in detail depending on the type of surgery that will be performed. Follow every single instruction of your doctor to ensure you are properly prepared for the surgery. If your child is having Airway Reconstruction surgery, then it is a good idea to have something that your child loves the most in the hospital. This will make him feel at ease and they will be more comfortable in the hospital. You can have a stuffed animal or toys they love the most. This can be great during the recovery process because they will have their favourite item with them.

There is a particular time, before the surgery, where you will have to avoid eating and drinking. Your doctor might advise you not to eat or drink anything for a few hours before the surgery. For children, the Airway Reconstruction surgery is usually scheduled for the morning time to ensure they have an empty stomach. The reason why you are advised against eating for a few hours before surgery is because it can lead to several complications if you eat or drink. An example of a complication is aspiration. If you eat or drink something by mistake, then the surgery will definitely be postponed.

Depending on the type of surgery that will be performed, you need to make arrangements accordingly. You may need to apply for leave in advance. Ask your doctor about how long you will need to stay in the hospital for so that you can make the necessary arrangements with regards to work and your home. You may need your partner to stay somewhere close to the hospital. Else if your child is the one who is having the surgery then you want to make arrangements to stay close-by so that you can visit often and spend time with your child. You should clearly ask your doctor about any questions you have regarding preparations.

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7.Complications and risks that may arise due to surgery

There are many risks associated with Airway Reconstruction surgery. Remember that these are risks so it is not 100% that you will have them. There is just a chance that you might have these problems.

  • You might experience side effects associated with anesthesia. Since the surgery requires anesthesia you might develop problems such as nausea, sore throat, sleepiness, and shivering. You might experience these for several days.
  • Pneumothorax can occur, although this is rare. Pneumothorax is when one or both of your lungs collapse either partially or completely. This can lead to damage to the pleura of the lung, when the surgery is taking place.
  • An infection can occur due to Airway Reconstruction surgery. You can tell if you have an infection if you have a fever of 38 degrees Celsius and if there is a discharge that is oozing out of your incision. You may notice that the area is inflammed.
  • You may experience difficulty in speaking, after the surgery. You might also notice that you have a sore throat. You will have a breathy voice as a result of the surgery. You might experience swallowing difficulties too as a result of the surgery.
  • Stent displacement or endotracheal tube displacement can occur if either is being placed until you recover. If the stent or tube dislodges then it can lead to complications such as subcutaneous emphysema which is a condition of air leakage to chest tissue.

The complications and risks depend on the type of Airway Reconstruction surgery performed. You should ask your doctor about any risks in advance so you are aware of what problems can occur.

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8.Understanding the procedure

Airway Reconstruction surgery

We are going to discuss the Airway Reconstruction surgery when open-Airway Reconstruction surgery is performed and when endoscopic reconstruction is performed. This will enable you to understand how each is performed.

Open-airway laryngotracheal reconstruction surgery:

Your doctor will decide whether this surgery will be done in one-stage or in multiple stages. He might want to use a variety of techniques when performing the surgery, depending on your case. Most people who undergo the Airway Reconstruction surgery have already had a surgery called tracheotomy. Hence, in the one stage reconstruction strategy, the tube is first removed if you had a tracheotomy surgery done earlier. After this, grafts are used to widen your airway. A graft is a cartilage from thyroid or the ribs that are cut into particular shaped pieces. The airway is widened by placing the grafts into the trachea in a proper way.

Following this, a tube is put into your mouth and then into the trachea. Your doctor can put the tube through your nose as well which is an alternative. This tube is called the endotracheal tube. The tube is placed such that the grafts are fully supported inside the trachea. Your doctor may decide to leave the endotracheal tube there for weeks or days. The number of days or weeks he will keep it there depends on how long the healing process. Healing depends on where the grafts are positioned and how many grafts are used.

Double-stage reconstruction surgery:

Your doctor reconstructs or widens your airway. This is done similar to the previous procedure where grafts are used and inserted in the trachea. In double-state reconstruction, the tube is left as it is. Alternatively, a stent is put in place.

Next, your doctor leaves it in place until the healing process is complete. This can take more than six weeks for some people. Your doctor will remove the tube in the next stage.

A method was introduced in 2013 which combined single-stage and double-stage reconstruction. This technique is called hybrid reconstruction. In this procedure, a lengthy stent is placed in the tube that is already in place. In addition, another stent that is shorter is placed through the trachea opening. This helps provide another airway through which you can breathe during the surgical procedure and post-surgery. Resection is another procedure that may be suggested by your doctor. There are cases where the windpipe’s narrow section might be removed altogether; the sections that remain are sewn together.

Endoscopic laryngotracheal reconstruction

This is a comparatively less invasive procedure than an open-Airway Reconstruction surgery. There are no incisions done in this procedure. It involves using a thin tube called a laryngoscope. This has surgical instruments along with a rod that has a camera and light attached to it. This tube is then inserted in your mouth and then into the airway. The surgery is then performed. Your doctor might use this method for placing grafts. Else, he may use balloons or lasers among other methods to widen the airway. Sometimes surgery is not the best choice, especially in people who have a very narrow airway.

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9.Road to recovery

Once the procedure is completed, you might need to be on a ventilator. This is especially true for children who are getting the surgery done. Sometimes sedation might be required so that the tube does not come off. The sedation duration and breathing help may depend on age and medical conditions. You will require time to heal after the Airway Reconstruction surgery. You will most probably be required to stay in the ICU until the airway heals. Your hospital stay might be anywhere between one week or more depending on your condition and how fast you are recovering from the surgery.

The time it takes to recover will depend on how complex your surgery was and whether any complications occurred after the surgery was completed. Sometimes, if the obstruction is severe then recovery might take longer. For people who have had endoscopic reconstruction, the recovery might be faster. This treatment option can be done on an outpatient basis and so there are chances that you may go home on the same day that you have been operated on. You may have to be in the hospital for a few days depending on how you are after the surgery completes.

Your doctor will recommend tests after surgery has been performed. The tests such as endoscopic tests will be done. Your doctor will tell you when you need to come in for tests. These tests help your doctor determine how the airway is healing and whether any problems have occurred. If any problem has occurred then it will be able to get treated faster, when diagnosed early. You will most probably have problems speaking or swallowing food and drinks, after surgery. Your doctor might recommend speech therapy or other therapies for that. The recovery process can be discussed with your doctor.

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10.Precautions to take

Your doctor will discuss the precautions that you need to take after the reconstruction surgery. The precautions will depend on the type of Airway Reconstruction surgery that you have. If you are not sure about the post-surgery care then you should outright ask this to your doctor. If there is anything that may be difficult to follow in terms of precautions then you need to address this to your doctor too. You should discuss precautions in advance when you are discussing the treatment option of Airway Reconstruction surgery. This will ensure you are able to take good care of yourself so you heal fast.

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11.Airway Reconstruction Surgery FAQs: All your concerns addressed

Q.   What are the questions I should ask my doctor if he suggests I get the Airway Reconstruction surgery done?

  1. The mistakes that most patients make is they don’t ask all their questions with the fear that they may sound stupid. This should never be done, you should be open with your doctor and tell him about your fears regarding the procedure. You should discuss everything. You should ask about the Airway Reconstruction cost, the procedure duration, and which technique will be used. You can ask specific questions about post-surgery such as Airway Reconstruction surgery exercises that you can safely do after surgery and so on. The key is to understand the procedure completely before you go for the surgery.
    Any question you think is worth asking should be asked. Your doctor will answer your questions provided you ask him whatever you need an answer for. Don’t forget to ask your doctor about your hospital stay, recovery and any other suggestions that he may want to give.

Q.   How do I know whether I have airway obstruction or not?

  1. The symptoms will depend on the airway obstruction you have. You might experience a lot of problems with regards to breathing. You might suffer from sleep apnea. You might notice that your voice has become hoarse. You might have a tough time eating and swallowing. Even when you try to swallow drinks, you have trouble doing that. If you think you might have airway obstruction and you might need surgery then it is best that you speak to a pulmonology specialist right away. He will be able to make the proper diagnosis and then suggest a treatment plan accordingly. Don’t forget to ask all the questions during your appointment with your doctor.

Q.   What tests are performed before the surgery?

  1. The goal of the tests is for your doctor to understand all the medical conditions that you have and to determine whether changes need to be made to the surgery plan. These tests help your doctor determine the right course of action post-surgery too. The following are some of the tests that can be performed.
    • Evaluating your voice is done to see whether you are having problems when talking. This helps your doctor determine the best treatment plan for you.
    • Pulmonary function tests are used to find out if you can handle the Airway Reconstruction surgery.
    • pH probe studies are done to see if the stomach acid is coming back up to the airway and the esophagus.
    • An endoscopic exam is performed to see the airway and how narrow it is. Your doctor might recommend gastrointestinal endoscopy to get a clear view of the stomach and esophagus.
    • CT scan and MRI exams may be done to detailed images of the airway passage and to see the lungs properly.
    • Sleep studies are performed to see whether the airway obstruction is causing any type of disturbance when you sleep.
    • Your doctor might perform tests to determine whether you are having any problems swallowing when you eat or drink.

Q.  My doctor said that I need to have other surgeries before the Airway Reconstruction surgery. Why is that?

  1. Your doctor might decide that other types of surgeries need to be performed before you have an Airway Reconstruction surgery. The following are three surgeries out of which your doctor might recommend one or more to be performed.
    • Nissen fundoplication is a procedure that is used for treating GERD or gastroesophageal reflux disease. This surgery helps to prevent the acid in the stomach to come up through the esophagus. GERD leads to inflammation which causes the airway to become narrow.
    • Tonsillectomy is also known as adenoidectomy. This surgery involves removing tonsils or adenoids. There are chances that tonsils or adenoids swell due to some infection which can lead to airway blockage, and this is why surgery may be necessary.
    • Supraglottoplasty is a surgery that helps repair the larynx which is the voice box. This can be necessary when the larynx tissue has partially collapsed. This is done by removing the obstructing tissue.

Q.  I heard that a laser can be used in the case of Airway Reconstruction surgery. What is that?

  1. Your doctor can recommend the use of a laser to treat narrowing of your airway. The laser treatment method makes cuts in the areas that have narrowed. Then the damaged trachea section is removed. The healthy bits of the trachea are then attached together. This can be done with the help of a balloon which helps widen the area. This helps to restore airway flow and you can breathe as usual. Whether you are applicable for this procedure or not depends on the results of the tests your doctor will perform such as bronchoscopy. It will depend on your medical history as well.

Q.  How long does a tracheal resection take?

  1. Children with scarring within their trachea need tracheal resection. The child’s neck is immobilized in a flexed position for one to two weeks, and the breathing tube is removed two to seven days after the surgery. The removal of the breathing tube depends on the condition of the child. The procedure may take anywhere from four to seven hours.

    After approximately a week after the surgery, the child needs to go for a follow-up visit to the hospital for a microlaryngoscopy bronchoscopy to evaluate the healing process.

Q.  What can cause narrowing of the trachea?

  1. The narrowing or constriction of the trachea is called tracheal stenosis. Most of the cases of tracheal stenosis are caused due to an injury from prolonged intubation when a breathing tube is placed into the trachea. The breathing tube is inserted during a medical procedure and when the trachea is surgically opened through a process called a tracheostomy.

    Narrowing of the trachea can occur due to a number of causes, such as:
    • External injury to the throat
    • Autoimmune disorders, such as sarcoidosis, polychondritis, papillomatosis, amyloidosis or Wegener’s granulomatosis.
    • Bacterial and fungal infections
    • Tuberculosis
    • Benign or malignant tumour pressing on the windpipe.

    Tracheal stenosis may also result as a side effect when radiation therapy is used to treat a tumour in the head or neck.

Q.  What is the common treatment for tracheal stenosis?

  1. In cases where the tracheal stenosis is the result of an underlying medical condition, the doctor will focus on the other issues before starting with the treatment of tracheal stenosis. Depending on the location and extent of the stenosis, surgery may be the preferred option. Some of the common surgical options include:
    • Tracheal resection and reconstruction: In this procedure, the constricted section of the windpipe is removed and the ends are re-joined.
    • Tracheal laser surgery: Lasers are used to remove the scar tissue causing the stenosis. But, in some cases, it may worsen the stenosis. Therefore, the underlying disorder is first identified before going for laser surgery to treat tracheal stenosis. Laser surgery can offer good short-term results and temporary relief but isn’t a long-term solution.
    • Tracheal dilation: Tracheal dilation involves the use of balloons or tracheal dilators to widen the trachea. It offers temporary relief and enables doctors to identify the area of the trachea that has been affected by the stenosis.
    • Tracheobronchial airway stent: Here, a metal, silicone or hybrid tube called a tracheal stent is placed at the site of the stenosis to keep the airway open. These stents are for both long-term and short-term use.

Q.  Who is at risk for an airway obstruction?

  1. Usually, children are more likely for an airway obstruction by foreign objects than adults. They may stick toys or small objects in their noses or mouths and won’t chew food well before swallowing. Other risk factors may include:
    • Birth defects or inherited diseases that can cause airway problems
    • Allergies to insect stings or certain foods such as peanuts
    • Smoking
    • Neuromuscular disorders and other conditions that make it tough for people to swallow food properly

Q.  What are the symptoms of airway obstruction?

  1. Different causes may produce different symptoms of airway obstruction. The symptoms also depend on the location of the obstruction. Some of them are:
    • Confusion
    • Cyanosis
    • Agitation
    • Panic
    • Difficulty breathing
    • Gasping for air
    • Unconsciousness

Q.  How can you prevent an airway obstruction?

  1. Many types of airway obstructions can be prevented by taking the following steps:
    • Eat slowly and take small bites of food
    • Avoid heavy consumption of alcohol before eating
    • Younger children may need supervising while they are eating
    • Chew thoroughly before swallowing
    • Keep small objects that could choke the trachea of children away from them
    • Quit smoking
    • If you have a condition that may lead to chronic airway obstruction, you need to pay regular visits to your doctor

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