What is Single Stage Laryngotracheal Reconstruction (SSLTR)?
Single stage laryngotracheal reconstruction (SSLTR) is a surgery done to make the airway larger by placing a graft in the area that is narrowed. Most grafts are made of ear cartilage, thyroid cartilage or rib cartilage.
The ENT doctor (ear, nose and throat) will decide what type of graft is best for your child. The ENT doctor will also decide where to place the graft:
- In the front of the airway (anterior)
- The back of the airway (posterior)
- Both, in order to make the airway larger
About the Surgery
The main surgery is followed by a series of scopes (microlaryngoscopy and bronchoscopy, or ML&B) in the operating room to check the airway for healing.
If your child has a tracheotomy tube, it will come out during the surgery and the hole (or stoma) will be closed.
There will be a cut in the neck where the surgery was done. A small drain will be in the neck to allow fluid and air to drain after the surgery. If rib cartilage is used, there will be a small cut on the chest and a drain will be in place after the surgery. The ENT doctor will decide how long the drains will remain in place.
A breathing tube will be in place through the nose after the surgery. The breathing tube holds the airway and graft in place while it heals so it does not shrink back down. The ENT doctor will decide how long the breathing tube needs to stay in place.
Your child will be cared for and closely watched in the intensive care unit (ICU) after surgery. The ICU doctors will closely monitor your child’s total care, while the ENT doctors will watch the airway. When your child is in the ICU, medicine will be given to help prevent them from pulling out their breathing tube. The medicine helps keep your child calm and rested.
Before the breathing tube is removed, children usually return to the operating room for an ML&B to see how well the airway is healing. The ENT doctor will decide when the breathing tube should be removed.
Once the breathing tube is removed, your child’s breathing will be watched. When the medicines that make your child sleepy are stopped, some children shake and are unsteady (also called withdrawal) for a short period of time.
The ENT doctor will decide when the next ML&B is needed, usually before discharge.
Once breathing is stable, the child will move to the airway unit for close monitoring. Children stay in the hospital while they progress with breathing on their own, are healing, and able to be fed by a tube in their stomach or food in their mouth.