Laryngotracheal Reconstruction & Voice Rehabilitation

Laryngotracheal reconstruction surgery is done to enlarge the windpipe (trachea) to make breathing easier. It is done for subglottic or tracheal stenosis.  The airway can be narrowed from birth or due to factors such as trauma, infection, prolonged intubation, and reflux of stomach juice into the glottis and subglottis, which is very irritating and causes delayed healing.

The windpipe can narrow in adults for the same reasons or additionally due to Wegener’s granulomatosis or sarcoidosis.

The goal of laryngotracheal reconstruction is:

1. To widen the airway and make it safe and stable for breathing
2. To help get rid of tracheostomy in people who already have a tracheostomy tube in the neck. What you can expect.

1.Before the procedure an endoscopyis done to assess the condition of the airway.

1. Pulmonary function tests determine lung condition.
2. CT scan and MRI tests may be used to further visualize anatomy and pre surgical planning
3. pH/impedance probe studies  to assess any acid reflux
4. Sleep studies (polysomnograms) 

Surgical procedures

Endoscopic and single-stage open-airway surgeries are generally recommended for mild cases of stenosis when your or your child’s airway isn’t severely narrowed.

Open-airway surgery involves making an incision in the neck to access the airway.

Open-airway laryngotracheal reconstruction can be done in one or multiple stages.

After the procedure

Your child may need help from a breathing machine (ventilator or respirator) or may need sedation to help prevent the breathing tube from coming out.

Most people stay in the hospital for seven to 14 days after open-airway laryngotracheal reconstruction surgery, although it may be longer in some cases.

Treatment and recovery after surgery vary depending on the procedure you or your child had. Full recovery may take a few weeks to several months.

In the weeks following surgery, the doctor performs regular endoscopic exams to check the progression of airway healing. Speech therapy may be recommended to help with any voice or swallowing problems.

Voice Rehabilitation Following Laryngectomy

After total laryngectomy, the natural voice is lost due to the removal of the voice box. Various methods can rehabilitate this. There are three ways of restoring your voice :

• Tracheoesophageal voice prosthesis insertion
• Electrolarynx use
• Esophageal voice

Tracheoesophageal Voice Prosthesis

The procedure involves placing a voice prosthesis in the stoma in the neck. The device allows air from the windpipe to move into the food pipe and create a voice

Disadvantages:

• More expensive and more difficult to maintain

Advantages:

• A more natural sounding voice is obtained

Electrolaryngeal Voice Device

An electrolarynx is a battery-operated electronic device that provides an artificial vibration to replace the vibration of the vocal cords.

Disadvantages:

• The voice obtained sounds very electronic

Advantages:

• Easy to use and less expensive

Oesophageal Voice

Oesophageal voice involves you swallowing air into the food pipe repeatedly and suddenly “burping” to create a voice.

Disadvantages:

• Hard to learn
• Not possible to do if  muscle mass is low e.g. in elderly people
• Speech is of very short duration

Advantages:

• Sounds more natural
• Inexpensive as no device is required

Voice rehabilitation requires teamwork between the surgeon, speech-language specialist, patient, and caregiver. Voice can be rehabilitated in almost all patients, and the choice of modality varies for each individual.