Specialist airway surgery · UK
Laryngotracheal reconstruction, at a UK specialist airway centre.
A rare, highly specialist operation to rebuild a narrowed larynx or trachea using the patient’s own rib cartilage. Only a handful of UK teams do it well — we make sure you reach one of them.
Why patients choose us
- 01
A specialist airway centre, not a generalist
Laryngotracheal reconstruction is done by a handful of UK airway teams. We route you to the right one — Great Ormond Street, Alder Hey, Birmingham Children’s, Nottingham, UCLH or Manchester.
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Endoscopic alternatives assessed first
Dilatation, laser and cricotracheal resection are on the table before open reconstruction. We say so, in writing, before you commit.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
The UK pathway
Laryngotracheal reconstruction is NHS-funded, at a specialist centre.
This is not a private-clinic operation. Every step below happens through NHS specialist commissioning — we help you get there faster and to the right team.
In short
Referred through the NHS to a named airway centre: GOSH, Alder Hey, Birmingham Children’s, Nottingham, UCLH, Manchester.
| Step in the pathway | Funding | Typical duration | Recovery / follow-up |
|---|---|---|---|
| Airway MDT assessment (NHS specialist centre) | NHS-funded | Half-day clinic | Referral pathway |
| Rigid airway endoscopy under GA (staging) | NHS-funded | 45–60 min | Same admission |
| CT airway with 3D reconstruction | NHS-funded | 20 min | 48–72 h |
| Endoscopic balloon dilatation (short-segment) | NHS-funded | 30–45 min | Day case |
| Cricotracheal resection (CTR) — specialist centre | NHS-funded | 4–5 h | ITU/HDU 5–10 d |
| Laryngotracheal reconstruction (single or two-stage) | NHS-funded | 3–5 h operation | ITU/HDU + weeks |
There is no private-sector equivalent of this pathway in the UK. The multidisciplinary airway team, paediatric or adult ITU, and airway-trained anaesthesia only exist in a small number of NHS centres. We help you reach them.
The problem
The right team, the right operation, the right centre.
Complex airway surgery is unforgiving. The volume and multidisciplinary experience of the team is the single biggest determinant of a good result — and it is not evenly distributed across the UK.
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Not sure open surgery is needed?
Dilatation, laser, steroid injection or cricotracheal resection may be a better first step. We say so before you commit.
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Worried about the anaesthetic?
A shared airway needs a planned technique. We route you to teams that do this weekly, not yearly.
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Want it done properly?
A named airway surgeon, a full MDT, and ITU support that is built for airway patients — not improvised on the day.
The journey
From referral to decannulation — what happens, in order.
One clinical team from first assessment through ITU recovery, stent removal and long-term airway follow-up.
Phase 1 · Before surgery
Assessment, MDT, planning
Phase 2 · On the day
Reconstruction and ITU
Phase 3 · After
Stent, SLT, decannulation
- 01
Before
You tell us what is going on
A short, confidential form. Cause of the airway narrowing (post-intubation, idiopathic, GPA, congenital), symptoms, prior procedures and any tracheostomy.
- 02
Before
We come back with a recommendation
Within one working day: the right airway centre, the right assessment pathway, and whether endoscopic treatment should be tried first. If open reconstruction is not the right step, we say so.
- 03
Before
Assessment is arranged
Rigid airway endoscopy under GA, flexible nasoendoscopy, CT of the airway and neck, pulmonary function tests, and an airway MDT — ENT, thoracic, anaesthesia, SLT and respiratory.
- 04
On the day
Arrival at the centre
Admission, consent and airway plan with the surgeon and anaesthetist. Anaesthesia is complex — spontaneous ventilation, apnoeic oxygenation, jet ventilation or cross-field intubation via the tracheostomy.
- 05
On the day
The reconstruction itself
A three to five hour operation. Midline neck incision, thyroid isthmus divided, anterior cricoid split with or without a posterior split, costal cartilage graft harvested from the 5th–8th rib, shaped and sutured into the airway.
- 06
On the day
ITU or HDU afterwards
ITU three to seven days for paediatric cases, HDU for adults. A luminal stent — endotracheal tube in single-stage, T-tube in two-stage — protects the graft.
- 07
After
Stent removal, SLT and decannulation
Direct laryngoscopy at stent removal (typically 5–14 days for single-stage, weeks to months for two-stage), then SLT, physiotherapy and gradual decannulation. Reviews and dilatations continue for months.
Typical end-to-end: weeks from assessment to surgery. Full airway recovery and decannulation: months.
When it helps
When laryngotracheal reconstruction is the right step.
The situations we see most, plus the one red flag that is an emergency airway rather than an appointment.
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Post-intubation subglottic/tracheal stenosis
The commonest cause in both adults and children — scarring from a period of ventilation that has narrowed the airway.
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Congenital subglottic stenosis
Children born with a narrowed subglottis (Myer-Cotton Grade 3–4) where the airway is not adequate for growth.
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Idiopathic subglottic stenosis
A scarring narrowing with no clear cause, predominantly in women aged 30–50 — often needing repeated dilatation before reconstruction.
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Post-tracheostomy stenosis
Scarring at or above a previous tracheostomy site that prevents decannulation and needs formal repair.
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Granulomatosis with polyangiitis (GPA)
Autoimmune airway inflammation that has scarred the subglottis — reconstruction only once the disease is quiescent on medication.
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Caustic ingestion or post-radiation scarring
A less common but destructive cause of long-segment airway narrowing that may need reconstruction or resection.
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Post-trauma or laryngeal cleft
Blunt or penetrating laryngeal trauma, or a posterior laryngeal cleft — repaired with cartilage graft techniques.
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Red flag: stridor at rest or cyanosis
Noisy breathing at rest, difficulty speaking through the noise, or a blue tinge is an emergency airway — 999 or A&E, not a clinic booking.
Procedure options
Open reconstruction is not the only option.
What each option on the table actually involves — and which fits which pattern of airway narrowing.
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Endoscopic balloon dilatation
For short, purely mucosal stenosis. Quick, repeatable, and often the first step — but higher recurrence than open surgery.
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Endoscopic laser + steroid injection
KTP or CO₂ laser plus intra-lesional steroid for granulation and short-segment scarring — a temporising or definitive option.
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Single-stage LTR (ssLTR)
Reconstruction with a costal cartilage graft and immediate decannulation, stented on an endotracheal tube for 5–14 days.
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Double-stage LTR
Tracheostomy retained during healing, a T-tube stent placed in the airway, and decannulation planned weeks to months later.
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Cricotracheal resection (CTR)
The stenotic segment is resected and the airway rejoined in a primary anastomosis — an alternative to LTR for isolated subglottic stenosis with an intact glottis.
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Slide tracheoplasty
For long-segment congenital tracheal stenosis in children — the trachea is divided and slid onto itself to double its diameter.
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Montgomery T-tube
A silicone T-tube that stents the airway for months or years — as a bridge to reconstruction, or occasionally as a long-term solution.
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Permanent tracheostomy
A last-resort airway when reconstruction is not feasible or has failed — offered honestly when it is the safest option.
The UK specialist centres
A short list of airway centres — we know them all.
Great Ormond Street, Alder Hey and Birmingham Children’s for paediatric airway. Nottingham, UCLH and Manchester for complex adult airway. We help you get to whichever fits your case.
What we look for
How we pick the right airway centre for your case.
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Complex airway MDT — ENT, thoracic, anaesthesia, SLT and respiratory around one table
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A named consultant airway surgeon, with recorded LTR and CTR volumes
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Endoscopic assessment and dilatation available first, before open surgery
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Paediatric or adult ITU with airway-trained nursing for the recovery window
Safety and recovery
What to expect afterwards — honestly.
Laryngotracheal reconstruction is a big operation with a long recovery. Outcomes in experienced centres are good — decannulation in 80–95% at one year — but further procedures are common.
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This is a specialist-centre operation
Laryngotracheal reconstruction is only offered in a handful of UK centres. The volume of the team matters more than any other single factor.
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Anaesthesia is complex
Sharing the airway between surgeon and anaesthetist needs a planned technique — spontaneous ventilation, apnoeic oxygenation, jet ventilation or cross-field intubation.
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ITU or HDU for days
Expect ITU three to seven days for children, HDU for adults. Sedation, humidified oxygen and airway toileting are the norm early on.
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Graft site pain is real
The costal cartilage is harvested from the 5th–8th rib. That wound is often more uncomfortable than the neck for the first fortnight.
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Voice and swallow change temporarily
Hoarseness, weak voice and difficulty swallowing are common in the early weeks. SLT input is part of the pathway, not an add-on.
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Further procedures are usual
Around a third of patients need additional endoscopic clearance, dilatation or minor revision after LTR. That is part of a normal course.
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Decannulation is a gradual process
For two-stage reconstruction, the tracheostomy is removed only once the airway is proven safe over successive checks — sometimes months out.
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Tracheo-innominate fistula is rare but catastrophic
Erosion of the tracheostomy into the innominate artery is very rare, but placement and follow-up are meticulous because of it.
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Red flags
New stridor at rest, sudden bleeding from the tracheostomy, spreading neck redness or a high fever after surgery are not normal — call the team the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the airway surgeon sends you keeps to the same shape.
A quiet reminder
Airway language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Cause, grade and length of the stenosis
The underlying cause (post-intubation, idiopathic, GPA, congenital), the Myer-Cotton grade, and the length and location of the narrowed segment.
- 02 Technique
Reconstruction technique and graft used
Whether single-stage or two-stage, anterior only or anterior plus posterior cricoid split, and the source of the cartilage graft (costal rib, auricular, thyroid alar).
- 03 Findings
Stent, tracheostomy and airway management
The stent used and planned removal date, whether the tracheostomy is retained, and the intra-operative airway plan and any events.
- 04 Impression
Recovery pathway and follow-up
Read this first: ITU/HDU expectation, stent removal timing, SLT and physiotherapy plan, and the schedule for endoscopic checks and possible dilatations.
Recognised by major UK insurers
Laryngotracheal reconstruction itself is NHS-funded through specialist commissioning. Private insurance may cover related private ENT consultation or expedited imaging where appropriate — we confirm before booking.
Frequently asked
Everything we get asked about laryngotracheal reconstruction.
Quick answers on where it is done, single vs two-stage, success rates and the recovery you should plan for.
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What is laryngotracheal reconstruction?
A complex ENT operation to widen a narrowed larynx or trachea — usually the subglottis. A piece of the patient’s own rib cartilage is shaped and sutured into a split in the airway wall to enlarge the lumen. It is done in a handful of specialist UK centres, in both children and adults.
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Why not just have a balloon dilatation instead?
For short, purely mucosal narrowing a balloon dilatation may be enough, and it is usually tried first. For longer, harder, cartilaginous stenoses — or where dilatation has failed repeatedly — open reconstruction gives a more durable airway.
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Which UK centres do laryngotracheal reconstruction?
It is a highly specialist operation. In children the main centres are Great Ormond Street, Alder Hey and Birmingham Children’s Hospital. In adults, complex airway work is concentrated at Nottingham, UCLH and Manchester, among a small number of others.
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Is this done privately?
In practice, no. Laryngotracheal reconstruction is delivered through NHS specialist commissioning for adults and paediatric airway centres for children — the multidisciplinary team, ITU support and airway expertise required do not exist in the private sector.
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What is the difference between single-stage and two-stage LTR?
Single-stage LTR removes the tracheostomy at operation and stents the airway on an endotracheal tube for 5–14 days. Two-stage LTR keeps the tracheostomy, places a T-tube stent inside the airway, and decannulates weeks or months later once the reconstruction has healed. The choice depends on the stenosis, the patient and the surgeon.
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How successful is it?
In experienced centres, 80–95% of patients are decannulated at one year. Around 30% need additional procedures — usually endoscopic clearance of granulation tissue or a further dilatation — as part of a normal course.
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What are the main complications?
Graft resorption or failure needing revision, recurrent stenosis, granulation tissue formation, wound infection, pneumothorax at the rib graft site, pain at that site, temporary swallowing difficulty, voice change, aspiration, tracheocutaneous fistula and — very rarely but catastrophically — tracheo-innominate fistula.
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How long is the recovery?
Expect ITU or HDU for several days, hospital admission for one to three weeks depending on the technique, and a gradual return to normal breathing, voice and swallow over months. SLT and physiotherapy are part of the pathway throughout.
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All tests & procedures
Every test and procedure we arrange.
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