Subglottic Stenosis/Laryngotracheal Reconstruction
Some children are born with or develop life-threatening narrowing of the upper portion of the windpipe (subglottis) and/or voice box (glottis). If the narrowing is in the subglottis it is called subglottic stenosis. If the narrowing is in the glottis it is called glottic stenosis. The factors which can cause the development of these narrowed airways are trauma, infection and reflux of stomach juice into the glottis and subglottis which is very irritating and causes delayed healing. Some children have so much airway narrowing that they cannot breathe and require the placement of an artificial airway through the neck into the windpipe below the narrow area called a tracheostomy.
For certain children with these problems, reconstructive surgery may be performed to widen the airway and allow removal of the tracheostomy tube. First, other medical problems, such as reflux of stomach juice or poor condition improves, reconstructive surgery is considered. Prior to any major reconstruction, scopes are passed (fiberoptic and rigid laryngoscopy and bronchoscopy) to determine all sites of narrowing in the airway from the nose to the bronchi of the lungs. Other areas of blockage of the airway are corrected, such as removal of large obstructing tonsils or adenoids. Then the airway reconstruction, called laryngotracheal reconstruction, can be performed.
In this type of surgery, the narrow areas of the glottis or subglottis are opened up, and carefully shaped pieces of the child’s own rib cartilage are placed to widen the narrow areas. Depending on the condition of the child and the severity of the narrowing in the airway, the period of healing may be selected to be short (7 to 14 days) or long (several months). Overall, the success rate for removal of the tracheostomy tube is quite high, although it is somewhat lower for children with the most severe airway narrowing.
