Surgery for Respiratory Problems in Neurologically Impaired Children

Some respiratory problems in neurologically impaired children require surgery to help relieve symptoms. Surgeons at Hassenfeld Children’s Hospital at NYU Langone recommend procedures to address irregularities that affect a child’s airway and improve breathing.

Experts at the Pediatric Aerodigestive Center, part of Hassenfeld Children’s Hospital, perform surgical procedures to widen narrowed airways or to remove obstructions, such as scars and other lesions. Surgery may be used to install or remove a tracheostomy tube, which helps a child breathe more adequately.

Tracheostomy

A tracheostomy is a plastic tube inserted into the trachea, or windpipe. This tube may be connected to a ventilator machine, which supplies oxygen to the lungs and removes carbon dioxide.

This procedure requires general anesthesia. The surgeon inserts a plastic tracheostomy tube through an incision in the neck and uses sutures, or stitches, to keep it in place.

Our specialists may use a three-dimensional printer to custom fit the tracheostomy tube. This allows doctors to better match the tube to the unique anatomy of your child’s airway.

After this surgery, your child remains in the hospital for a week. Our experts teach you how to care for the tracheostomy tube before your child goes home.

Decannulation

When children no longer need a tracheostomy tube to assist in breathing, it is removed in a procedure called decannulation.

In this procedure, our specialists use laryngoscopy and bronchoscopy to check the child’s airway for obstructions. Then they assess the child’s ability to breathe through the mouth and nose by placing a cap over the tracheostomy tube.

If there are signs of breathing difficulties, the cap is removed. If there are no difficulties, the tube is capped overnight while the child sleeps. Heart rate, breathing, and oxygen levels are monitored overnight.

If the child shows no signs of breathing difficulties overnight, a surgeon removes the tracheostomy tube the next day and covers the incision. Your child remains in the hospital for 24 to 48 hours for observation.

Four to six weeks after decannulation, your child visits the surgeon to check the incision’s healing.

Scoliosis Repair Surgery

Some neurologically impaired children have a curvature of the spine, or scoliosis, which can interfere with a lung’s ability to expand and take in oxygen. Surgery on the spine can help improve a child’s ability to breathe.

Neurosurgeons and orthopedic and plastic surgeons at Hassenfeld Children’s Hospital perform several types of procedures to improve a spinal curvature that is affecting a lung. These include spinal fusion to fuse together vertebrae causing the curvature, fusionless surgery using expandable rods placed in the back, and thoracoplasty to remove or shorten a protruding rib.

Our surgeons perform these spinal surgeries using general anesthesia. These procedures may involve rods, screws, titanium ribs, or small pieces of bone, called bone grafts. Recovery depends on the type of surgery performed.