Complex Pediatric Airway Reconstruction, Swallowing and Tracheostomy

We are one of the nation’s few programs dedicated to caring for children with complex airway disorders and swallowing conditions.

Doctor assessing child patient while mother holds her

Why Choose the UCLA Health Complex Pediatric Airway Reconstruction, Swallowing and Tracheostomy Program

Our program is one of the few in the nation dedicated to children with complex airway and swallowing disorders. Board-certified specialists in numerous fields collaborate to give your child comprehensive, next-level care. When you choose UCLA Health, you can expect:

Renowned excellence: UCLA Health's head and neck surgery program is widely known for its outstanding quality, regularly ranked among the nation's top programs by U.S. News & World Report. Numerous physicians from our program are also listed among Los Angeles Magazine's “Top Doctors” and “Super Doctors” in Southern California.

Compassionate care: We prioritize your child’s comfort and well-being, offering individualized support throughout their treatment journey.

Family-centered approach: You are actively involved in your child’s care, and we ensure that you are fully informed at every stage and work with you to develop a complete treatment plan.

Complex airway surgery: We’re among a select few centers in the country with the expertise to perform a slide tracheoplasty to widen a child’s windpipe and improve breathing. This complex procedure requires the combined surgical skills of a pediatric ear, nose and throat (ENT) doctor and a pediatric cardiothoracic surgeon.

Multidisciplinary airway clinic: Our Pediatric Aerodigestive Clinic enables your child to see multiple specialists during one coordinated visit. Your child sees an ENT doctor for airway issues, a gastroenterologist for swallowing problems and a speech-language therapist for assessments and therapies.

Research focus: Our doctors are also active researchers who regularly publish their work about airway and swallowing care. That means your child has access to the latest treatments and innovations.

Our Specialties

Our pediatric specialists work together to deliver comprehensive care. Your child’s care team may include specialists in:

Ear, nose and throat (otolaryngology)
Heart and chest (cardiothoracic surgery)
Respiratory care (pulmonology), including respiratory therapy
Digestive and swallowing disorders (gastroenterology)
Skull and face (craniofacial surgery)
Speech-language pathology

Complex Pediatric Airway and Swallowing Disorders We Treat

Breathing, speaking and swallowing can be difficult when structures in a child’s respiratory system are diseased, narrowed or obstructed. These structures include:

Throat (pharynx)
Voice box (larynx)
Windpipe (trachea)

Some children are born with airway and swallowing conditions (congenital). Others develop them from trauma, disease or prolonged use of a breathing tube.

Our team treats the most complex airway and swallowing conditions in children, including:

Breathing problems

We treat all types of airway conditions that affect a child’s breathing, including:

Airway stenosis: Narrowing of the airways causes hoarseness or difficulty breathing. Types include glottic stenosis, subglottic stenosis and tracheal stenosis.
Complete tracheal rings: Cartilage rings in the windpipe are too small and completely closed in the shape of an O instead of the usual open C-shape. The complete rings make breathing harder and noisier.
Laryngomalacia: Laryngomalacia is the most common cause of noisy breathing (stridor) in infants. The tissues above the vocal cords are soft and floppy, causing a partial airway obstruction.
Stridor: Stridor is noisy breathing caused by vocal cord paralysis or a narrowed, or obstructed airway.
Tracheostomy dependence and tracheostomy-related disorders: Prolonged use of a tracheostomy tube to aid breathing can cause various complications.

Swallowing disorders

Common swallowing disorders in children include:

Cricopharyngeal achalasia: The muscle at the top of the food pipe (esophagus) doesn’t relax, making swallowing difficult.
Dysphagia and aspiration: Dysphagia is the medical term for when a child has trouble swallowing. Swallowing difficulties can cause food and liquid to enter the windpipe and lungs (aspiration).
Laryngeal (laryngotracheal) cleft: An abnormal opening between the throat and food pipe allows food and liquid to enter the lungs. The opening may extend to the windpipe.
Tracheoesophageal fistula: An abnormal connection between the food pipe and windpipe allows food and liquids to reach the lungs.

Voice-related conditions

Voice disorders can stem from many causes, such as:

Complex voice disorders: Vocal cord growths, scarring and paralysis, muscle tension imbalances, and chronic laryngitis cause complex voice disorders.
Glottic diastasis: An abnormal gap between the vocal cords can cause voice problems.
Recurrent respiratory papillomatosis: Noncancerous (benign) wart-like growths from the human papillomavirus (HPV) form on or near the vocal cords, causing hoarseness, voice changes and breathing difficulties.
Vocal fold paralysis: The vocal cords (sometimes called vocal folds) don’t move as they should, affecting breathing and speech.

Tests and Procedures We Offer

Your child’s doctor may refer you to a pediatric ear, nose and throat (ENT) doctor (otolaryngologist). Pediatric otolaryngologists have specialized training in children’s airway and swallowing conditions. They work with you and other pediatric specialists to develop an effective treatment plan for your child.

Diagnosing complex pediatric airway and swallowing disorders

Our providers use several tests to diagnose airway and swallowing problems in children, including:

Lab tests

Your child’s doctor may request samples of blood, urine or tissues to analyze in a lab. Information from lab tests can provide valuable health insights.

Imaging

Your doctor may request detailed pictures of your child’s airways, lungs and blood vessels. Common imaging tests include:

Chest X-ray: This technique uses electromagnetic radiation to capture images of your child’s chest.
CT scan: This imaging test combines X-rays and advanced computers to produce detailed images of your child’s respiratory system.
MRI: An MRI uses radio waves, high-powered magnets and a computer to create detailed images of your child’s airway structures.
Esophagram (barium swallow study): Your child swallows a safe barium solution that coats the food pipe. The doctor watches your child’s swallowing action during a specialized X-ray called fluoroscopy.
Modified barium swallow study: Similar to a barium swallow, this test checks to see if food or liquids enter your child’s lungs.

Endoscopic imaging tests

We insert a flexible or rigid tube with a light and camera at the end (endoscope) through the nose or mouth to view portions of your child’s airway. Specialized endoscopic tests we perform in our office include:

Laryngoscopy: Views the voice box
Flexible (fiberoptic) endoscopic evaluation of swallowing: Focuses on the swallowing process
Bronchoscopy: Looks at the windpipe
Esophagoscopy: Evaluates the food pipe
Endoscopic biopsy: Takes tissue samples to be analyzed in a lab
Triple endoscopy: Evaluates the airway, lungs and upper digestive tract in a single endoscopic procedure in the hospital

Treating complex airway conditions and swallowing disorders

Most airway treatments aim to widen the airway and remove obstructions to make breathing easier. Depending on your child’s specific diagnosis and needs, their airway treatment may include oral medications, injections, surgery or a combination. We offer:

Nonsurgical treatments for complex pediatric airway conditions

Medications can help treat some airway conditions. Your child’s doctor may also recommend injecting steroids into the airway structures to reduce inflammation.

Endoscopic treatment for complex pediatric airway conditions

When possible, our doctors use minimally invasive procedures, including:

Ablation therapy: Your child’s doctor uses lasers to destroy scar tissue or tumors in the airway. This method usually offers a faster recovery time than traditional surgery.
Dilation: This procedure uses a tiny, removable inflatable balloon to stretch and open the airway.
Stenting: Your child’s doctor inserts a metal or silicone tube (stent) to keep the airway open.

Open surgical procedures to treat complex pediatric airway conditions

Some procedures require open surgery, which involves a skin incision to access the airway. We offer all complex airway surgical procedures for the voice box and windpipe.

Complex airway surgery (slide tracheoplasty)
We’re among a select few centers in the country with the expertise to perform complex surgical procedures to correct an airway narrowing in newborns, infants and children. This complex pediatric airway reconstruction requires the surgical skills of both a pediatric ENT surgeon and pediatric cardiothoracic surgeon.

One such procedure, a slide tracheoplasty, helps a child with a long-segment narrowed windpipe (tracheal stenosis) breathe better. Our pediatric ENT surgeon treats the windpipe section in the neck while our pediatric cardiothoracic surgeon performs surgery on the windpipe section in the chest. These surgeons collaborate to perform complex airway repairs, sometimes requiring the use of a heart-lung (bypass) machine.

Voice box (larynx) procedures
Voice box procedures we perform include:

Epiglottopexy: This procedure treats sleep and airway problems in children. Your child’s doctor secures the floppy tissue that covers the windpipe while eating (epiglottis) to the tongue to open the airway.
Laryngeal cleft repair: This procedure involves using endoscopic or open surgical techniques to manage laryngeal clefts.
Laryngeal reinnervation: This procedure restores nerve connections in the voice box, helping the vocal cords function.
Laryngotracheal reconstruction (laryngotracheoplasty): This procedure treats congenital or acquired airway stenosis. The doctor removes a small piece of cartilage from elsewhere in your child’s body (a graft). Then they insert the graft in the windpipe to widen it and make breathing easier.
Supraglottoplasty: This procedure treats laryngomalacia. Your child’s doctor uses specialized lasers on the tip of an endoscope to reshape or remove excess tissue in the voice box.

Windpipe (trachea) procedures
We also perform complex windpipe surgeries, such as:

Cricotracheal and tracheal resection: This procedure treats advanced airway stenosis. Your child’s doctor removes the narrowed portion of the airway and reconnects the healthy sections.
Tracheoesophageal fistula repair: Your child’s doctor separates the windpipe and food pipe and closes the openings in each passageway.
Tracheostomy: A doctor makes an opening in the windpipe to insert a tracheostomy tube to help a child with an airway disorder breathe.
Tracheostomy decannulation: This is the process of removing a tracheostomy tube.

Meet our team

Our otolaryngologists are highly trained specialists in complex pediatric airway problems and swallowing disorders. They work closely with other pediatric specialists to manage your child’s condition and improve their quality of life.