Objective Children with congenital or acquired airway conditions involving the supraglottic, glottic, and/or subglottic airway require complex airway management. Tracheotomy with later surgical intervention for reconstruction and expansion of the airway is often necessary. The effect of the necessary surgeries to improve airway patency may also impact upon the laryngeal functions of phonation and airway protection during swallowing. The purpose of the present project was to analyze diagnosis, surgical intervention, and laryngeal findings in a cohort of patients undergoing laryngotracheal reconstruction.
Methods A retrospective review of 46 patients was completed. Type of airway lesion, surgical approach and number of airway surgeries, past and present history of feeding/swallowing dysfunction, past and present laryngeal findings, and voice outcomes were tabulated.
Results The most common diagnosis in the patient cohort was prematurity and/or prolonged intubation resulting in subglottic stenosis. Co-existing morbidities present in the majority of patients including developmental delay, gastroesophageal reflux disease, and congenital syndromes. The majority of patients had undergone >2 airway surgeries. Common post-operative laryngeal findings associated with swallowing dysfunction included restricted vocal fold mobility, lateralized vocal folds, and supraglottic scarring. Voice outcomes revealed moderate to severe dysphonias secondary to variable sources of laryngeal vibration for voicing. Patients who did not display swallowing dysfunction following airway reconstruction were noted to demonstrate greater supraglottic compression for voicing.
Conclusions Laryngeal closure for adequate airway protection requires supraglottic compression. Continued research is needed to delineate the relationship between aspects of laryngeal reconstruction and resulting long term voice and swallowing outcomes.