1) Be able to define Laryngotracheal Reconstruction (LTR).

2) Understand reasons for Laryngotracheal Reconstruction (LTR).

3) Understand considerations before LTR surgery.
4) Be able to explain the process of Laryngotracheal Reconstruction.
5) Understand considerations after LTR surgery.
- born premature at 33 weeks
- required endotracheal intubation at birth
- noisy & difficult breathing as an infant
- Subglottic stenosis (77%)
- underwent a tracheotomy at 12 months
- parents fear complications of long term tracheostomy tube
use
- definition = a surgery in which a small piece of
cartilage is inserted into a narrowed section of
the trachea in order to widen the windpipe and
make breathing easier
- primary goal = to establish a permanent, stable
airway for breathing without a tracheostomy
tube
(Childrens Hospital of Pittsburgh,n.d.) (Mayo Clinic, n.d)
1) Malformation of the larynx
2) Weak cartilage
3) Vocal fold paralysis
4) Narrowing of the airway (stenosis)
* most common

(Mayo Clinic, n.d.)
- Two types:
A) glottic stenosis - in the glottis

B) subglottic stenosis - in the subglottis, just
beneath the vocal folds
http://www.youtube.com/watch?v=rX1zP3wM8ao - subglottic stenosis example

(Childrens Hospital of Pittsburgh, n.d.)
(The Childrens Hospitial of Philidelphia, n.d.)
- ideal timing for LTR:
- <25 months (Zalzal et al., 1997)
- variety of scopes are used to determine all sites of
narrowing in the airway (Childrens Hospital of Pittsburg, n.d.)
- other areas of blockage are corrected (Mayo Clinic, n.d.)
1) An incision is made at the point of narrowing
in the trachea.
2) Cartilage is typically harvested from the 6-
8th rib, it is shaped and sewn into the
cartilage edges of the tracheal incision.
3) The airway is opened to allow greater
airflow.
4) The rib cartilage grows with the child and
trachea.
(ENTforkids, n.d.)

-Can be done in one or multiple stages, using different
techniques, depending on the severity of your or
your child's condition.
1) Single-stage reconstruction

2) Double or multi-stage reconstruction
(Mayo Clinic, n.d.)

http://www.youtube.com/watch?v=Vx-WtdR3R4M#t=96 (Childrens Hospital of Philadelphia, n.d.)



- Period of healing depends on the child

- Healing times could range from 7 days to several
months


(Childrens Hospital of Pittsburgh, n.d.)
-Success rates are lower for children with more severe narrowing of the airway.
-Success Rates at the Great Ormond Street Hospital over 10 years:
Grade 1: 100%
Grade 2: 92.3%
Grade 3: 88.1%
Grade 4: 83.3%
(Bajaj et al., 2012)
-The combination of a complete preoperative airway evaluation, meticulous
surgical technique, and several new measures during surgery has led to
LTRs with a higher success rate. (Yellon et al., 1997).
- Outcomes are based on successful airway restoration (Krival et al., 2007)
-Altered larynx
-Dysphonia
-Low pitch and reduced pitch range, breathiness,
hoarseness, reduced vocal intensity,& reduced
maximum phonation time
-Those who used primarily supraglottic vibrations vs.
glottic vibrations exhibited significantly worse
overall severity, roughness, and pitch deviance.
(Krival et al., 2007)



- Speech and Language Therapy (ENTforkids, n.d.)

-Voice Therapy (Krival et al., 2007)


Harrys parents decided to go through with LTR
surgery.
Schedule immediately for better speech and
language outcomes
See better long term outcomes with LTR and the
removal of his tracheostomy tube

-About Subglottic Stenosis:
http://www.chop.edu/service/airway-
disorders/conditions-we-treat/subglottic-stenosis.html
-About Laryngotracheal Reconstruction:
http://www.mayoclinic.org/tests-
procedures/laryngotracheal-reconstruction/basics/why-
its-done/prc-20019217

Yellon, R., Paramesaran, M., & Brandom, B. (1997). Decreasing morbidity following laryngotracheal reconstruction in children.
International Journal of Pediatric Otorhinolaryngology, 41, 145-154.
Bajaj, Y., Cochrane, L., Jephson, C., Wyatt, M., Bailey, C., Albert, D., et al. (2012). Laryngotracheal reconstruction and cricotracheal
resection in ildren: Recent experience at Great Ormond street Hospital. International Journal of Pediatric
Otorhinolaryngology, 76, 507-511.
Zalzal GH, Choi SS, Patel KM. Ideal Timing of Pediatric Laryngotracheal Reconstruction. Arch Otolaryngol Head Neck Surg.
1997;123(2):206-208. doi:10.1001/archotol.1997.01900020094014.
Krival, K., Kelchner, L., Weinrich, B., Baker, S., Lee, L., Middendorf, J., et al. (2007). Vibratory source, vocal quality and fundamental
frequency following pediatric larygotracheal reconstruction. International Journal of Pediatric Otorhinolaryngology, 71,
1261-1269.
Laryngotracheal Reconstruction. (n.d.). Laryngotracheal Reconstruction. Retrieved April 24, 2014, from
http://www.chp.edu/CHP/Laryngotracheal+Reconstruction
Laryngotracheal reconstruction. (n.d.). surgery Why it's done. Retrieved April 24, 2014, from
http://www.mayoclinic.org/tests-procedures/laryngotracheal-reconstruction/basics/why-its-done/prc-20019217
Subglottic Stenosis | The Children's Hospital of Philadelphia. (n.d.). Subglottic Stenosis | The Children's Hospital of Philadelphia. Retrieved
April 24, 2014,
from http://www.chop.edu/service/airway-disorders/conditions-we-treat/subglottic-stenosis.html
Laryngotracheoplasty. (n.d.). ENTforKidscom RSS. Retrieved April 24, 2014, from
http://entforkids.com/patient-education/other/laryngotracheoplasty