Name of the Procedure:

Tracheoplasty; cervical (commonly referred to as cervical tracheoplasty).

Summary

Cervical tracheoplasty is a surgical procedure to repair or reconstruct the trachea (windpipe) in the neck (cervical area). It is performed to widen or stabilize the trachea to ensure proper breathing.

Purpose

This procedure addresses conditions such as tracheal stenosis (narrowing of the trachea), tracheomalacia (weakness of the tracheal walls), and other structural abnormalities of the trachea. The goal is to restore normal airway function, allowing for easier and safer breathing.

Indications

• Severe or symptomatic tracheal stenosis
• Recurrent respiratory infections due to tracheal abnormalities
• Difficulty breathing not relieved by less invasive treatments
• Congenital tracheal malformations
• Tracheal injuries or trauma causing obstruction

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Medication adjustments may be required; blood thinners often need to be paused.
• Pre-operative assessments such as imaging studies (CT scan, MRI) and pulmonary function tests.
• Anesthesia evaluation to determine the appropriate anesthesia plan.

Procedure Description

1. The patient is administered general anesthesia.
2. A horizontal incision is made in the neck over the trachea.
3. The trachea is exposed, and necessary measurements and assessments are made.
4. Defective or narrowed portions of the trachea are removed or reshaped.
5. The trachea is then reconstructed using grafts, stents, or other surgical techniques.
6. The incision is closed with sutures, and the area is bandaged.

Special tools include surgical scalpels, forceps, tracheal grafts (if needed), and stents. Advanced technology such as an endoscope may be employed to visualize the tracheal lumen during the procedure.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the tracheal repair.

Setting

Tracheoplasty is performed in a hospital operating room due to the need for specialized equipment and anesthesia.

Personnel

The surgical team usually includes a thoracic or ENT (ear, nose, and throat) surgeon, anesthesiologist, surgical nurses, and possibly a respiratory therapist.

Risks and Complications

• Infection at the surgical site
• Bleeding and hematoma formation
• Tracheal restenosis (narrowing again)
• Injury to surrounding structures (esophagus, recurrent laryngeal nerve)
• Anesthesia-related complications
• Swallowing difficulties

Benefits

Patients can expect a significant improvement in breathing function and a reduction in symptoms associated with tracheal stenosis or malacia. Benefits typically become evident within days to weeks after surgery.

Recovery

• Patients may stay in the hospital for a few days post-procedure for monitoring.
• Pain management with prescribed medications.
• Instructions to avoid strenuous activities and heavy lifting for several weeks.
• A follow-up appointment to monitor healing and airway function.
• Possible temporary dietary restrictions to allow the trachea to heal properly.

Alternatives

• Endoscopic dilation: Less invasive but often temporary.
• Tracheal stenting: Provides immediate relief but may require eventual replacement.
• Medical management, such as corticosteroids or antibiotics: Useful for managing symptoms but not curative.

Patient Experience

Patients will be under general anesthesia during the procedure, so they will be unconscious and unaware. Post-procedure discomfort and mild pain are common, managed with medication. Some patients may experience temporary hoarseness or difficulty swallowing. Regular follow-up appointments are crucial to ensure proper healing and function.