Overview

Airway Reconstruction surgery is also known as laryngotracheal reconstruction surgery. It is a surgery option used to widen the narrow windpipe called the trachea. This type of surgery is also recommended by your doctor when something obstructs your windpipe and 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. Children often require Airway Reconstruction surgery because some are born with physical abnormalities, but adults may need it when their windpipe narrows due to a variety of reasons. Let us delve deeper into the procedure, risks and recovery from airway reconstruction surgery.

Reasons Airway Reconstruction Surgery is Performed

The benefit of 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 - It is considered a better option than a tracheotomy.
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 made through the neck and into the windpipe.

Conditions That Require Airway Reconstruction Surgery

Numerous conditions require Airway Reconstruction surgery. Some of the most common conditions are as follows.

Stenosis : Stenosis requires Airway Reconstruction surgery because the airway becomes narrow. Stenosis causes include disease, infection, and injury. One reason for stenosis is an irritation associated with the insertion of a breathing tube in newborn babies with congenital conditions. Stenosis can affect the windpipe, vocal cords, or the windpipe below the vocal cords.
Tracheomalacia : It refers to weak cartilage, usually in infants. In this condition, the immature cartilage of the child is soft and not strong enough to remain stiff enough to maintain a clear airway. It makes it difficult for children to breathe.
Vocal Cord Paralysis : Vocal cord paralysis might require Airway Reconstruction surgery. In this condition, either or both of the vocal cords cannot function properly. Sometimes, the vocal cords cannot open, which can cause breathing difficulty because the airway is obstructed. Vocal cord paralysis has various causes, including stroke and injury.
Laryngotracheal Tumour : A laryngotracheal tumour can obstruct the airway, blocking proper breathing. This is because inflammatory tissue can build up in the trachea and narrow the airway, causing breathing difficulties.
Windpipe Injury : An injury to the windpipe caused by an accident can cause problems with the airway and require Airway Reconstruction surgery. If the neck area has been stabbed or if an object hits the neck, this can also cause airway problems.
Inflammatory diseases : Diseases such as asthma can lead to inflammation of the airways, which can obstruct air from passing through them. Asthma is a respiratory condition that makes breathing difficult. Infections can also cause airway conditions and may require Airway Reconstruction surgery.
Reflux Disease : Reflux disease is one of the common problems people suffer from. It can lead to inflammation, which in turn can cause breathing problems. It may require Airway Reconstruction surgery so that you can breathe normally.
Poorly formed Larynx : When the larynx is not formed correctly, it can cause airway problems. In some people, this may be the case at birth, where the larynx cannot form ultimately. It is known as laryngeal cleft. It can happen when tissue grows abnormally, obstructing the larynx. It can also occur due to an infection or scarring from a medical procedure.
Wegener's granulomatosis : Granulomatosis with polyangiitis can cause blood vessel inflammation and requires Reconstruction surgery. In this condition, various tissues in the body are inflamed. It mainly affects the kidneys and the respiratory tract. It can affect people of any age, and the cause of this condition is unknown.

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

Types of Airway Reconstruction Surgery

There are two ways to perform Airway Reconstruction surgery: open-airway surgery or an endoscopic medical procedure. In open-airway reconstruction surgery, an incision is made to perform the surgery. In an endoscopic procedure, instruments are inserted through the mouth.

Are You The Right Candidate for Airway Reconstruction Surgery?

It would help if you spoke to your doctor about whether you are a good candidate for Airway Reconstruction surgery.

Mild Stenosis : Usually, the two types of reconstruction surgeries are recommended for children or adults when the stenosis is mild. When the airway is not too narrow, your doctor will recommend the surgery. Your doctor will discuss any other problems you are dealing with, such as other medical issues and if you experience symptoms that may point to different problems. Once he does that, he can decide and let you know if you are eligible for Airway Reconstruction surgery.
Severe Stenosis : People with severe stenosis must take a different approach. It applies to people with medical problems that complicate Airway Reconstruction surgery. Such conditions include those 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. The medical procedures are divided so that you have them within a few weeks or even years. It depends on your condition and health.

How Do I Prepare for the Procedure?

Your doctor will explain the preparation for Airway Reconstruction surgery in detail, depending on the type of surgery that will be performed. Here are some things to keep in mind when preparing for the procedure.

Follow every single instruction of your doctor to ensure you are adequately prepared for the surgery.
If your child is having Airway Reconstruction surgery, having something your child loves most in the hospital is a good idea. It will make him feel at ease, making them more comfortable in the hospital.
There is a particular time before the surgery when 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 in the morning to ensure they have an empty stomach. You are advised against eating for a few hours before surgery because eating or drinking can lead to several complications, including aspiration. The surgery will be postponed if you eat or drink something by mistake.
Depending on the type of surgery, 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 so that you can make the necessary arrangements regarding work and your home.
You may need your partner to stay somewhere close to the hospital. Otherwise, if your child is having the surgery, you want to make arrangements to stay close by so that you can visit often and spend time with your child.
You should ask your doctor about any questions you have regarding preparations.

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% certain that you will have them. There is just a chance that you might have these problems.

You might experience side effects associated with anaesthesia. Since the surgery requires anaesthesia, you might develop problems such as nausea, sore throat, sleepiness, and shivering. You might experience these for several days.
Although it is rare, pneumothorax can occur. Pneumothorax occurs when one or both lungs collapse wholly or partially. When surgery is performed, this can damage the lung's pleura.
An infection can occur due to Airway Reconstruction surgery. You can tell if you have an infection by having a fever of 38 degrees Celsius and discharge oozing out of your incision. You may also notice that the area is inflammed.
You may experience difficulty 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.
If either is placed until you recover, stent or endotracheal tube displacement can occur. If the stent or tube dislodges, it can lead to complications such as subcutaneous emphysema, a condition characterised by air leakage to chest tissue.

The complications and risks depend on the type of Airway Reconstruction surgery performed. It would help to ask your doctor about any risks in advance so you know what problems can occur.

Understanding the Procedure

We will discuss Airway Reconstruction surgery, when open-airway reconstruction surgery is performed, and when endoscopic reconstruction is performed. It will enable you to understand how each is performed.

1. Open-airway laryngotracheal reconstruction surgery: Your doctor will decide whether this surgery will be done in one stage or multiple stages. Depending on your case, he might want to use various techniques when performing the surgery. 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 the thyroid or ribs cut into particular-shaped pieces. The airway is widened by adequately placing the grafts into the trachea.

Following this, a tube is put into your mouth and the trachea. Your doctor can also put the tube through your nose, which is an alternative. This tube is called the endotracheal tube. The tube is placed so the grafts are fully supported inside the trachea. Your doctor may 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 is. Healing depends on where the grafts are positioned and how many are used.

2. Double-stage reconstruction surgery: Your doctor reconstructs or widens your airway. This procedure is similar to the previous one, 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 until the healing process is complete. It 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 that combined single-stage and double-stage reconstruction. This technique is called hybrid reconstruction. In this procedure, a lengthy stent is placed in the already in place tube. In addition, another shorter stent is placed through the trachea opening. It helps provide another airway to breathe during the surgical procedure and post-surgery. Resection is another procedure that your doctor may suggest. In some cases, the windpipe's narrow section might be removed altogether; the remaining sections are sewn together.

3. Endoscopic laryngotracheal reconstruction: This is a comparatively less invasive procedure than an open-Airway Reconstruction surgery. No incisions were made during this procedure. It involves using a thin tube called a laryngoscope. It has surgical instruments and a rod with a camera and light attached. 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. Otherwise, he may use balloons or lasers to widen the airway. Surgery is sometimes not the best choice, especially for people with narrow airways.

Road To Recovery

Ventilator - Once the procedure is completed, you might need to be on a ventilator. It is especially true for children who are getting the surgery done.
Sedation- 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 need time to heal after the Airway Reconstruction surgery.
ICU Stay- 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.
Recovery Time- 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, 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, so 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 is completed.
Tests- 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, it can be treated faster when diagnosed early. After surgery, You will probably have problems speaking or swallowing food and drinks. Your doctor might recommend speech therapy or other therapies for that. The recovery process can be discussed with your doctor.

Precautions To Take

Your doctor will discuss the precautions you must take after the reconstruction surgery. The precautions will depend on the type of Airway Reconstruction surgery that you have. If you need more post-surgery care clarification, ask your doctor. If there is anything that may be difficult to follow regarding precautions, you must also address this with your doctor. You should take precautions in advance when discussing the treatment option for Airway Reconstruction surgery. It will ensure you can take good care of yourself and heal quickly.

Frequently Asked Questions

Q1. What questions should I ask my doctor if he suggests I get the Airway Reconstruction surgery done?
A1. The mistake that most patients make is they only ask some of their questions with the fear that they may sound stupid. It should never be done; you should be open with your doctor and tell him about your concerns regarding the procedure. You should discuss everything. It would help if you asked 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 you can safely do after surgery. The key is to understand the procedure completely before you go for the surgery.

You should ask any question you think is worth asking. 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.

Q2. How do I know whether I have airway obstruction or not?
A2. The symptoms will depend on the airway obstruction you have. You might experience a lot of problems about 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 have airway obstruction and need surgery, it is best to speak to a pulmonology specialist immediately. He can make the proper diagnosis and then suggest a treatment plan accordingly. Remember to ask all the questions during your appointment with your doctor.

Q3. What tests are performed before the surgery?
A3. The goal of the tests is for your doctor to understand all your medical conditions and determine whether changes need to be made to the surgery plan. These tests also help your doctor determine the right course of action post-surgery. 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. It helps your doctor determine the best treatment plan for you.
Pulmonary function tests determine if you can handle the Airway Reconstruction surgery.
pH probe studies are done to see if the stomach acid is returning to the airway and the oesophagus.
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 oesophagus.
CT scans and MRI exams may be performed to provide detailed images of the airway passage and to examine the lungs correctly.
Sleep studies are performed to see whether the airway obstruction is causing any disturbance when you sleep.
Your doctor might perform tests to determine whether you have problems swallowing when you eat or drink.

Q4. My doctor said I must have other surgeries before the Airway Reconstruction surgery. Why is that?
A4. 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 used to treat GERD or gastroesophageal reflux disease. This surgery helps prevent stomach acid from coming up through the oesophagus. GERD leads to inflammation, which narrows the airway.
Tonsillectomy, also known as adenoidectomy, involves removing tonsils or adenoids. An infection can cause tonsils or adenoids to swell, leading to airway blockage, so surgery may be necessary.
Supraglottoplasty is a surgery that helps repair the larynx, the voice box. It can be necessary when the larynx tissue has partially collapsed. The obstructing tissue is removed.

Q5. I heard that a laser can be used in airway reconstruction surgery. What is that?
A5. Your doctor can recommend using a laser to treat the 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. It can be done with the help of a balloon, which widens the area. It helps to restore airway flow, and you can breathe as usual. Whether you are eligible for this procedure depends on the results of the tests your doctor will perform, such as a bronchoscopy. It will depend on your medical history as well.

Q6. How long does a tracheal resection take?
A6. 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.

Approximately a week after the surgery, the child needs to go for a follow-up visit to the hospital for a micro-laryngoscopy bronchoscopy to evaluate the healing process.

Q7. What can cause the narrowing of the trachea?
A7. narrowing or constriction of the trachea is called tracheal stenosis. Most cases of tracheal stenosis are caused by 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 tracheostomy process.

Narrowing of the trachea can occur due to several 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.

Q8. What is the common treatment for tracheal stenosis?
A8. In cases where tracheal stenosis results from an underlying medical condition, the doctor will focus on the other issues before treating tracheal stenosis. Surgery may be the preferred option depending on the location and extent of the stenosis. Some of the standard 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 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 using balloons or tracheal dilators to widen the trachea. It offers temporary relief and enables doctors to identify the area of the trachea 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.

Q9. Who is at risk for an airway obstruction?
A9. Usually, children are more likely to have airway obstruction by foreign objects than adults. They may stick toys or small objects in their noses or mouths and not 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 challenging for people to swallow food properly

Q10. What are the symptoms of airway obstruction?
A10. 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

Q11. How can you prevent an airway obstruction?
A11. 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 visit your doctor regularly.