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Pediatric Airway Reconstruction

Pediatric airway reconstruction is a surgical procedure designed to remove tracheostomies from children who have scars that narrow their airways. The scarring occurs for a variety of reasons, such as prolonged intubation or trauma. Pediatric airway reconstruction may also be useful for children born with narrow airways that don’t have a tracheostomy but suffer from recurrent croup episodes or exercise intolerance. 

When the narrowing is just below the glottis (vocal cords), we call this narrowing subglottic stenosis. When the airway narrowing is lower down in the trachea (airpipe), we call this tracheal stenosis. Subglottic stenosis is characterized by four grades with grade 1 being the mildest and grade 4 being the most severe.

There are two different surgical approaches that may be used to treat subglottic stenosis. The first approach, laryngotracheal reconstruction, aims to make the airway bigger. Sometimes rib grafting is used in laryngotracheal reconstruction to help achieve the best result. A second approach, cricotracheal resection, is designed to remove the scarred airway and bring the sections just above and below the scarred area together.

Surgery for tracheal stenosis is divided into primary resection and reanastomosis (tracheal resection and re-anastomosis) or a procedure for longer sections of narrowing called a slide tracheoplasty.