Name of the Procedure:

Laryngoplasty for Laryngeal Stenosis with Graft, Without Indwelling Stent Placement (Pediatric, Under 12 Years)

Summary

Laryngoplasty is a surgical procedure to widen a narrowed airway (laryngeal stenosis) that can cause breathing difficulties. For children under 12, this procedure involves grafting tissue to expand the airway without the use of a long-term stent.

Purpose

The procedure addresses laryngeal stenosis, which can make breathing difficult. The goal is to improve airway patency (open and unobstructed airway) to facilitate normal breathing and prevent airway obstruction.

Indications

• Symptoms such as stridor (noisy breathing), difficulty breathing, and hoarseness
• Diagnosed laryngeal stenosis confirmed by endoscopy or imaging
• Previous treatments have not been effective, or the condition is severe

Preparation

• Fasting from midnight before the procedure
• Adjustments to medications as directed by the physician
• Preoperative assessments including blood tests, imaging studies, and an anesthesiology evaluation

Procedure Description

1. Anesthesia: The child receives general anesthesia to ensure they are asleep and pain-free.
2. Incision: A small incision is made in the neck to access the larynx.
3. Graft Placement: Tissue (often from rib cartilage) is harvested and grafted to expand the narrowed laryngeal area.
4. Closure: The incision is closed with sutures or surgical glue.
5. Monitoring: Post-surgery, the child's breathing is closely monitored to ensure the graft is functioning correctly.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity.

Setting

Conducted in a hospital, usually within an operating room equipped for pediatric surgeries.

Personnel

• Pediatric Otolaryngologist (ENT Surgeon)
• Anesthesiologist specializing in pediatric care
• Surgical Nurses and Operating Room Technicians
• Post-Anesthesia Care Unit (PACU) staff

Risks and Complications

• Common: Infection, bleeding at the incision site, temporary swelling
• Rare: Graft rejection, persistent airway issues, need for additional surgeries
• Management: Close postoperative monitoring and appropriate interventions

Benefits

• Improved airway function
• Enhanced breathing ability
• Reduction in breathing-related symptoms
• Benefits often realized within the first few weeks post-surgery

Recovery

• Immediate: Initial stay in the hospital for monitoring (usually 1-2 days).
• Short-term: Instructions to avoid strenuous activities, soft diet recommendations, and medication for pain.
• Follow-up: Subsequent visits to monitor healing and airway function.
• Long-term: Full recovery can take several weeks, with minimal restrictions on regular activities after healing.

Alternatives

• Medical management with inhaled medications or steroids
• Less invasive endoscopic procedures (limited in effectiveness)
• Other surgical options like tracheostomy (more invasive, requiring long-term care)
• Pros and Cons: Laryngoplasty provides a more permanent solution with fewer long-term complications but involves surgical risks.

Patient Experience

• During: The patient will be under general anesthesia and will not feel the procedure.
• After: Some pain and discomfort managed with prescribed medication. The child might experience mild sore throat and hoarseness initially.
• Comfort measures: Pain management, soft foods, and rest to support healing.