Innovative care for children with complex airway disorders
Airway disorders include a wide variety of conditions that affect a child’s breathing passages. The airway is made up of structures called the larynx (voice box), pharynx (the back of the mouth and nose), trachea (windpipe) and bronchi (lung passages).
The Airway Disorders Program in the division of Pediatric Otolaryngology (ENT) at C.S. Mott Children’s Hospital offers a multidisciplinary approach to diagnosing and treating airway disorders. We collaborate with pediatric pulmonology, pediatric cardiothoracic surgery, pediatric surgery, pediatric gastroenterology and pediatric speech-language pathology to provide comprehensive care.
Our program was designed to provide specialized treatment exclusively for children with airway disorders - from providing an accurate diagnosis to creating individualized treatment plans for each child - with a focus on supporting your family each step of the way. We have a track record of combining evidence - based medicine with innovative technologies to optimize the potential for children with these complex conditions.
What are airway disorders?
Our Airway Disorders Program team cares for children with a variety of congenital and acquired airway conditions, including:
- Airway masses, cysts, tumors and cancers
- Laryngeal clefts
- Sleep apnea and airway obstruction related to craniofacial disorders, including micrognathia, Pierre Robin syndrome
- Stridor or noisy breathing in infants and young children
- Subglottic hemangiomas and other, vascular anomalies, tumors and cancers
- Subglottic stenosis
- Tracheal stenosis
- Tracheomalacia and tracheobronchomalacia.
- Vascular rings and complete tracheal rings
Vocal cord paralysis and hoarseness
The team also offers expertise in long-term management of tracheostomies as well as tracheostomy removal (decannulation), which may require surgical intervention.
Diagnosing airway disorders
Accurate diagnosis is the first step to an effective plan of care. Your child will be evaluated by a highly skilled team with expertise in complex airway disorders. Our airway specialists use a wide array of state-of-the-art tools to make accurate diagnoses:
- Flexible fiberoptic nasolaryngoscopy
- Microlaryngoscopy with specifically-designed pediatric surgical instruments
- Bronchoscopy, both rigid and flexible
- Specialized protocols for CT scan of neck and chest, MRI and ultrasound imaging of the airway
- Pulmonary function testing (PFT), including endoscopic-assisted PFT and exercise-induced PFT and for infants.
- Airway fluoroscopy
- Sleep studies, including for infants and young children
Treatment for airway disorders
The C.S. Mott Children’s Hospital team is committed to supporting both the short and long-term medical needs of our patients.
For those children who require surgery, we offer expertise in the full range of surgical techniques available to give patients the most up-to-date and effective options for resolving their airway disorders.
We offer cutting-edge airway reconstruction options to maximize the chances of decannulation or even avoid a tracheostomy, with a goal of offering your child the best possible quality of life:
- Laryngotracheal reconstruction, a procedure to repair narrowing or scarring of the windpipe by surgically implanting a small piece of cartilage into the windpipe to widen and stabilize the airway.
- Partial cricotracheal resection, a procedure in which the narrowed part of the airway just below the voice box is removed, and the voice box and windpipe (trachea) are sewn back together. We are experienced in performing resection of long segments, including the longest segment resection successfully performed.
- Slide tracheoplasty, a procedure where the trachea is spliced onto itself to enlarge the airway. We have successfully repaired stenosis extending from the larynx into the mainstem bronchi.
- Endoscopic laryngotracheal cleft repair, a procedure to fix a cleft between the esophagus and trachea.
- Treatment of laryngeal webs and cysts using microscopic instruments as well as the laser to restore normal anatomy and function.
- Repair of laryngeal agenesis, a procedure where vocal cords are constructed from existing tissue.
- Aortopexies and vascular pexies, a procedure performed in collaboration with pediatric cardiothoracic surgery in which the aorta, pulmonary artery or innominate artery is anchored anteriorly to relieve pressure on the airway.
- Vocal cord (laryngeal nerve) reinnervation, a procedure for vocal cord paralysis in which the surgeon takes a branch of the ansa cervicalis, a motor nerve in the neck, and sews it to the recurrent laryngeal nerve, the nerve that gives the vocal fold mobility and tone.
- EXIT procedure, a procedure for delivering a baby where the airway is secured before the child is separated from the mother’s circulation.
- Endoscopic surgery, laser microlaryngoscopy and laser bronchoscopy, procedures where a laser is used to treat lesions or scarring within the airway. We also perform balloon dilations of the airway to treat airway narrowing.
- Mandibular distraction osteogenesis, a procedure where airway obstruction secondary to Pierre Robin sequence or micrognathia (small jaw) is improved by enlarging the jaw.
- Tumor and cancer resection and reconstruction
Our otolaryngologists are among a very small number of surgeons nationwide with experience performing state-of-the-art airway reconstructive procedures. We were the first and are currently the only medical center in the country to have used innovative 3D printing technology to create stents to support airways for children with tracheomalacia and other complex airway disorders. Our surgeons frequently team up with renowned specialists from throughout the University of Michigan Health System as well as the School of Engineering to bring the latest technologies to our patients in creative, life-changing ways.
Rehabilitation and support
We have pediatric and neonatal intensive care specialists with great experience in optimizing the postoperative experience after airway reconstruction, including comfort and sedation. Your child will have access to our specialized pediatric social work team and child life therapists to understand and cope with his or her condition and treatment. We also coordinate with our respiratory care, anesthesiology pain service, and speech-language pathology teams to provide integrated support for children.
Take the next step:
Through groundbreaking innovation and unparalleled patient care, the otolaryngology team at C.S. Mott Children’s Hospital is giving children with complex airway disorders new hope. We look forward to the opportunity to be a part of your family’s care team.
Schedule an appointment by calling us at 734-936-8051.