Treatment for subglottic stenosis depends on how severe child’s symptoms are.
- Mild subglottic stenosis — The child may not need any intervention. They will need to see the doctor on a routine basis though.
- Moderate or Severe subglottic stenosis — The child may need surgery to make the size of the airway larger. This will help them breathe easier. In some cases, your doctor may want to do a tracheotomy below the level of airway narrowing. This will give your child a safe airway and to make it easier to breathe.
When your child is ready, your doctor may start procedures for airway reconstructive surgery. This may include:
This type of surgery is used for children with mild to moderate subglottic stenosis. Using a camera, narrow parts are divided and/or widened using special balloons.
If your child has moderate to severe narrowing, a more complex treatment may be needed. This surgery is done to enlarge the part with narrowing or stenosis. There are two main ways open surgery can be done.
Laryngotracheal Reconstruction (LTR) or Laryngotracheoplasty (LTP)
In LTR, the narrowed part of the windpipe, right below the voice box, is widened. This is done by putting a graft or piece of cartilage into the airway. Most grafts are made of cartilage from the rib, but cartilage from the ear or thyroid are also used. The surgery is done in a single stage or in steps, based on your child's condition.
Single stage (SSLTR): If your child has a tracheostomy tube, it will be removed at the time of surgery. Your child will have a breathing tube placed through their nose after surgery. The breathing tube holds open the airway and supports the repair site while the graft heals and gets stronger. While the breathing tube is in, your child may need to be sedated and ventilated by a respirator. In many cases, the repair site is checked in the operating room before taking out the breathing tube.
Double stage (DSLTR): There are two options with this surgery. Your child may have a stent (hollow tube-like device) placed in the airway above their tracheotomy tube (trach). The ENT doctor may decide to use a T-tube instead of using a trach and stent. A T-tube is like a trach and stent, but it is all-in-one. The stent or T-tube holds your child’s airway open while the graft heals. Your doctor will decide how long the T-tube or stent stays in place.
Cricotracheal Resection (CTR) or Cervical Slide Tracheoplasty
In a CTR and cervical slide tracheoplasty, the narrow part of the trachea is removed. Then the healthy ends of the trachea are reattached. This surgery may be done in a single stage or in steps.