Complete Tracheal Rings

What Are Tracheal Rings?

The trachea (windpipe) is made up of cartilage, which is also called tracheal rings.  Normally, tracheal rings are “C” shaped.   Complete tracheal rings are “O” shaped.  The “O”-shaped rings are always smaller than the normal “C” shape and may make it harder to breathe due to a narrower trachea. 

Complete tracheal rings are a rare condition present at birth.  It is usually associated with other vascular (blood vessel), heart, or lung abnormalities.

Children with complete tracheal rings may have associated malformations, cardiac and pulmonary anomalies, Down syndrome, and Pfeiffer syndrome. Tracheal rings can be associated with a condition in which the pulmonary artery wraps around the trachea and causes it to compress, narrowing the opening.

Children with complete tracheal rings have noisy breathing which gets worse over time.  Typically, their breathing sounds like a “washing machine”  because of the noise made when they breathe in and out. 

Some children may have to work harder to breathe, causing a sucking in around their ribs and chest (called retractions).  Some children may also have trouble with feeding.  Colds or respiratory illness can also make breathing worse.

Complete tracheal rings are diagnosed with a microlaryngoscopy and bronchoscopy.  Sometimes the child may need other X-rays or tests to evaluate for other vascular (blood vessel), heart, or lung abnormalities.

We take a holistic approach to assessing and diagnosing our patients. We assess all aspects of a child and individualize a treatment plan that encompasses all levels of care. Doctors in multiple disciplines work together to determine the best course of action for your child. Your child’s needs are discussed with you and your family, leading to an integrated, customized treatment plan.  

Some children, who have few symptoms, do not need surgery.  These children are watched regularly for airway growth or any changes in their symptoms.  However, most children need surgery to make their airway bigger because as their body grows, their airway would otherwise stay the same size.

The tracheal narrowing caused by complete tracheal rings usually occurs in the upper part of the trachea, and may be corrected through a neck incision. If the narrowing of the trachea is lower, a sternotomy (incision through the sternum) may be needed for repair. In some instances it may be fixed endoscopically (through the mouth), sometimes with temporary placement of a stent (device to maintain an opening).

The two most common forms of repair are slide tracheoplasty (which shortens the trachea, but makes it much wider), or increasing the size of the narrow area with cartilage grafts. Slide tracheoplasty involves opening the trachea in the front and the back. It is slid up on itself and reconnected to make the trachea (windpipe) shorter, but much wider.

If grafts are needed laryngotracheal reconstruction (LTR) also known as laryngotracheoplasty (LTP) is performed. This is a procedure in which the narrowed portion of the windpipe is widened with cartilage grafting. Most grafts consist of cartilage taken from the ear, thyroid or rib. Depending on a patient's condition, the surgery may be performed in a single stage or in multiple steps.

Single Stage (SSLTR) 

Your child will have a breathing tube (also known as an endotracheal or ETT) that will be placed through the nose after surgery. The breathing tube holds open the airway and supports the repair site.

Double Stage (DSLTR) 

A stent will be placed above the tracheotomy tube, or a T-tube will replace the tracheotomy tube, holding open the airway and supporting the repair site as the incision and graft heal. Your doctor will decide how long the T-tube or stent will be in place.

Call your doctor if your child is having any breathing difficulty.

If you have any questions, contact the Division of Pediatric Otolaryngology / Head and Neck Surgery at Cincinnati Children’s, 513-636-4355,

Last Updated 03/2015