Laryngotracheal Reconstruction (LTR) — Double-Staged Repair

A double-stage laryngotracheal reconstruction (also called laryngotracheoplasty or LTR) involves a repair of the narrowed airway, with the trach left in place during the healing process. The tracheostomy tube will be removed once the area of reconstruction has fully healed.

Video showing double-stage laryngotracheoplasty, with anterior and posterior rib cartilage graft, before, during and after the repair.

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.

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 days. She 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.