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What Is Laryngotracheal Reconstruction?

Laryngotracheal reconstruction is airway surgery used to widen a narrowed subglottic or upper tracheal airway. The surgeon opens the narrowed airway and expands it with one or more cartilage grafts, commonly harvested from a rib. The graft enlarges the airway framework rather than removing a long stenotic segment. The procedure is used mainly for selected subglottic or laryngotracheal stenosis in children and adults.

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What Is Laryngotracheal Reconstruction?

Laryngotracheal reconstruction is airway surgery used to widen a narrowed subglottic or upper tracheal airway. The surgeon opens the narrowed airway and expands it with one or more cartilage grafts, commonly harvested from a rib. The graft enlarges the airway framework rather than removing a long stenotic segment. The procedure is used mainly for selected subglottic or laryngotracheal stenosis in children and adults.

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Why Is Laryngotracheal Reconstruction Performed?

The procedure is considered when airway narrowing causes clinically significant breathing problems and endoscopic treatments are inadequate or unlikely to provide durable relief. Causes include acquired stenosis after prolonged intubation or tracheostomy and selected congenital airway narrowing. Surgeons assess the location, length, and severity of stenosis as well as vocal-fold function and other airway conditions. Very severe stenosis or poor mucosal quality can make cricotracheal resection or another airway procedure more appropriate.

How Is Laryngotracheal Reconstruction Performed?

The surgeon exposes the narrowed larynx and trachea through a neck incision and splits the airway framework at the stenotic segment. Cartilage grafts are shaped and inserted into the front, back, or both sides of the airway to increase its diameter. A single-stage reconstruction can remove an existing tracheostomy and support the airway with an endotracheal tube, while a double-stage reconstruction commonly leaves a tracheostomy or stent temporarily in place. The airway is closed around the grafts and monitored closely during healing.

What Is Recovery Like After Laryngotracheal Reconstruction?

Recovery requires close airway monitoring because swelling, mucus, graft movement, or stent problems can affect breathing. Patients can require intensive care, temporary ventilation, a tracheostomy, or an airway stent depending on the reconstruction. Voice, swallowing, oxygenation, wound healing, and airway size are assessed during follow-up. Bronchoscopy is commonly used to examine graft healing and determine when a stent or tracheostomy can be removed.

What Are the Risks and Complications?

Possible complications include infection, bleeding, airway swelling, pneumonia, granulation tissue, graft displacement, and restenosis. Voice changes can occur when surgery involves structures close to the vocal folds or when scar tissue affects laryngeal function. Stents can become blocked, displaced, or promote granulation tissue and require additional procedures. Failure to maintain an adequate airway can lead to repeat reconstruction, cricotracheal resection, or continued tracheostomy.

Frequently Asked Questions About Laryngotracheal Reconstruction

Does laryngotracheal reconstruction use cartilage grafts?

Yes. Rib cartilage is commonly used to expand the narrowed airway, although graft choice and placement depend on the reconstruction.

What is the difference between single-stage and double-stage LTR?

Single-stage reconstruction aims to maintain the airway without a tracheostomy during healing, while double-stage reconstruction commonly retains a tracheostomy or stent temporarily.

Is laryngotracheal reconstruction the same as cricotracheal resection?

No. Laryngotracheal reconstruction expands the airway with grafts, while cricotracheal resection removes a stenotic segment and reconnects healthy airway ends.

Can airway narrowing return after laryngotracheal reconstruction?

Yes. Restenosis or granulation tissue can narrow the airway again and can require dilation, endoscopic treatment, revision reconstruction, or another operation.

References

Subglottic Stenosis. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK563265/. Date Accessed August 13, 2026.

Double Stage Laryngotracheal Reconstruction. Cincinnati Children's Hospital Medical Center. https://www.cincinnatichildrens.org/health/l/laryngotracheal-reconstruction. Date Accessed August 13, 2026.

Laryngotracheal reconstruction for pediatric glotto-subglottic stenosis. PubMed. https://pubmed.ncbi.nlm.nih.gov/25022423/. Date Accessed August 13, 2026.

Anterior and posterior cartilage graft dimensions in successful laryngotracheal reconstruction. PubMed. https://pubmed.ncbi.nlm.nih.gov/16785408/. Date Accessed August 13, 2026.

Laryngotracheal reconstruction in infants and children. PubMed. https://pubmed.ncbi.nlm.nih.gov/21982078/. Date Accessed August 13, 2026.