Airway Reconstruction

Airway reconstruction is a surgical procedure performed to widen your windpipe to make breathing easier. During this procedure, a small piece of cartilage (connective tissue found in many areas of your body), is inserted into the narrowed section of the windpipe to make it wider. This procedure can be performed using the following methods: Non-Invasive (no incisions required / small puncture / low to moderate sedation) or minimally-invasive (small incisions of 2–3 inches long / general anesthesia). The type of method chosen will vary according to your particular health condition.

Children most commonly experience problems with a narrowed windpipe, although the problem can also occur in adults. It can occur for many reasons, including injury, infection, stomach acid reflux, a birth defect or as the result of the insertion of a breathing tube. An adult's windpipe can become narrowed for the same reasons, but the cause may also be a disease that causes blood vessel or tissue inflammation, such as Wegener's granulomatosis or sarcoidosis.

The goal of an airway reconstruction is to provide a safe and stable airway without the use of assistance from a breathing tube.

How to Prepare for Airway Reconstruction

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before Airway Reconstruction

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests, including:

• Bronchoscopy
• Pulmonary function tests
• Blood tests
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Voice evaluation test
• Ambulatory acid (pH) probe test
• Sleep study

What to Expect During Airway Reconstruction

The procedure will typically takes 3 hours to complete. This procedure is typically performed in the operating room (OR). Check with your doctor about the details of your procedure. In general, during a minimally-invasive airway reconstruction:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, your doctor will administer general anesthesia (make you feel sleepy).
• Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• The doctor inserts a rigid bronchoscope (thin tube with a light and camera) to the location of the obstruction in the trachea.
• Next, a piece of cartilage grafted from the patient’s ear or rib is placed carefully to permanently widen the airway.
• Once this is complete, the doctor will remove all instruments and you will be moved to the recovery area.

What to Expect After Airway Reconstruction

After the surgery, you will be taken to the cardiothoracic intensive care unit (CTICU) for 7 to 14 days until the airway heals. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Ambulation is started on the first or second day of surgery.
• Urine catheters are removed after 24 to 72 hours.
• You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
• Receive several different medicines to relieve pain. Patients will be given long-acting oral pain medication, NSAIDS, IV pain medication and multi-level intercostal nerve blocks.
• Your doctor will give you instructions to follow during your recovery.