Laryngotracheal Reconstruction with Cartilage Grafting (LTR)

What is laryngotracheal reconstruction with cartilage grafting (LTR)?

This highly specialized procedure is done to treat a narrowing of the windpipe. The narrowing may be caused by a previous breathing tube or an injury. Less often, a child is born with a narrow windpipe. Sometimes the condition is mild and doesn’t need treatment. If the windpipe is too narrow to support comfortable breathing, growth, and development, the child may need LTR.

What are the different ways to repair the airway?

At the Aerodigestive and Airway Reconstruction Center at Lucile Packard Children’s Hospital Stanford, we perform many kinds of reconstruction. The surgical approach is based on a child’s unique physical structures and possible other lung, heart, or gastrointestinal conditions.

LTR surgery may be open (through an incision in the neck) or endoscopic (using a camera and instruments that go through the mouth), depending on the amount of expansion that is needed, the child’s age, and the kinds of grafting material (cartilage) used. During the operation, a surgeon makes the airway larger by inserting a piece of cartilage. This is usually a piece of the child’s rib, but it could be taken from other areas of the child’s body.

Our team has a multidisciplinary approach to surgery and works closely with pulmonary (lung), gastrointestinal (GI), and speech-language pathology (SLP) specialists throughout Packard Children’s to evaluate a child and determine the best timing for the LTR, based on all of the child’s health conditions and concerns.

• During a single-stage graft expansion, the reconstruction and removal of the breathing tube, or tracheostomy tube (trach), are done at the same time. The child no longer needs a trach after this surgery. If a child does not already have a trach, single-stage operation is an option.
• During a double-stage graft expansion, the reconstruction is done with the tracheostomy tube in place. Once the child has recovered and if all goes well, the tracheostomy tube can be removed. This may be a few weeks to years after the surgery.

What happens after the procedure?

After surgery, children go to one of our intensive care units (ICUs) where there is a dedicated team to take care of children who have had this procedure. As children recover, they often (continue to) work with a speech-language pathologist trained in LTR to optimize outcomes related to voice and swallowing.

Our patients are often also seen at other programs at Packard Children’s, including the Center for Pediatric Voice and Swallowing Disorders, the Pediatric Vocal Cord Dysfunction Clinic (Paradoxical Vocal Fold Motion Disorder), Pediatric Heart Surgery, and Gastroenterology, Hepatology and Nutrition.