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Toddler's voicebox reconstructed at Lucile Packard Children's Hospital

Imagine learning soon after your baby's birth that his doctors have serious concerns about his health. That was what happened to Fresno, Calif., parents KC and Rebecca Jackson when their son Noah was born in 2009. Because of a rare genetic disease, baby Noah had such a narrow airway that he couldn't cry and struggled to breathe. At five days old, he had a tracheostomy tube implanted to allow air to bypass his constricted voicebox. The "trach" let him breathe but also made it impossible for him to vocalize. The Jacksons hoped the trach could eventually be removed, but there were no guarantees.

Packard Children's otolaryngologist Peter Koltai, MD, is adept at a complex, multi-stage procedure to reconstruct children's voice boxes. Every bit of Koltai's expertise was needed when he treated Noah, because the little boy had the most complicated form of voice box obstruction - stage 4 subglottic stenosis.

A story I wrote chronicles Koltai's work:

Koltai and his team opened Noah's voice box and removed the scar tissue that blocked Noah's airway.

"The scar came up to the bottom of the vocal cords, but we were able to dissect them free," Koltai said. The team then used two pieces of rib cartilage from Noah's chest to enlarge the framework of the voice box. The new airway was supported with a stent inserted through the center; Noah would keep breathing through his trach until the airway was fully functional.

A month after the stent was removed, Noah had a check-up.

"The reconstruction had worked well below the level of the vocal cords," Koltai said, but problems remained. "Because the vocal cords had been involved in scarring, they had fused back down like a zipper, almost totally closed," he added, explaining that this not only prevented Noah from speaking, but also jeopardized his ability to breathe normally.

Read the whole article to find out how a medical device that Koltai invented allowed him to re-open the airway and enable Noah, who is now 3 1/2, to breathe, speak and tell his (thrilled) parents what he wants to be when he grows up.

Photo courtesy of the Jackson family

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