What is Cricotracheal Resection (CTR)?
CTR is a surgery in which the narrowed part of the airway just below the voice box (larynx) is removed and the voice box and windpipe (trachea) are sewn back together. It is also used to treat other airway problems.
Depending on where the narrowing is, this may be done as a single stage (one step) surgery or a staged (multiple step) surgery.
If your child has a tracheotomy tube, it would be removed in the single stage.
In the staged surgery, a stent would be placed above the tracheotomy tube.
About the Surgery
There will be a cut in the neck where the surgery was done. Your child will also have a small drain in the neck to allow fluid and air to drain after surgery. This drain will be removed when your ENT doctor feels it is ready to come out, usually two to three days after surgery. All children who have this procedure will have chin-to-chest sutures (stitches) that will remain in place seven to 10 days. These sutures are placed from the skin of the lower chin to the upper chest and are used to prevent the child from moving the head too far back. In some cases, a neck brace may be worn instead of sutures. This keeps the airway stitches from pulling apart.
If done in a single stage (SSCTR), 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.
If done in a double stage (DSCTR), a stent will be placed above the tracheotomy tube or a T-tube will be placed instead of the tracheotomy tube. The T-tube or stent will be used to hold open the airway and support the repair site. Your ENT doctor will decide how long the T-tube or stent will be in place.
After a Single Stage CTR Surgery
Your child will be cared for and closely watched in the intensive care unit (ICU) after surgery. The ICU doctors will monitor your child's total care while the ENT doctors will care for the airway. While your child is in the ICU, medications may be given to help prevent him from pulling out his breathing tube. These medications make him sleepy but comfortable. Your child may require a ventilator to help with his breathing, especially if he is sedated from the medication required.
Before the breathing tube is removed, your child will return to the operating room for a micro laryngoscopy and bronchoscopy (MLB) to see how well the airway is healing. Your ENT doctor will decide when the breathing tube should be removed.
Once the breathing tube is removed, your child's breathing will be closely monitored. When the medications that make your child sleepy are stopped, some children experience jitteriness or slight unsteadiness (also called withdrawal) for a short period.
Your ENT doctor will decide when the next MLB is needed, usually before discharge. Once breathing is stable, your child will be transferred to a high acuity unit (also called the airway unit) for monitoring. As your child continues to progress with breathing easily, tolerating feedings and healing overall, she will be cared for in the hospital until ready for discharge.
After a Double Stage CTR Surgery
Your child will be cared for and closely monitored on the airway unit after surgery. Children with a stent or T-tube often have difficulty swallowing after the surgery. A speech therapist will work with your child to assist with swallowing and eating after the surgery.
You will need to learn how to care for your child's tracheotomy tube or T-tube and demonstrate your knowledge. You should feel comfortable with this care before going home.
Arrangements will be made for any equipment you will need to care for your child at home before you leave the hospital. The ENT doctor will decide when another MLB will be scheduled after discharge.