Advanced Care for Complex Airway Conditions
Treatments offered by BIDMC's Complex Airway Program include surgical and endoscopic procedures.
The Complex Airway Program is a regional and national referral center providing comprehensive, multidisciplinary care for patients with a range of malignant and benign airway disorders.
We have particular expertise in the endoscopic and surgical management of complex benign airway disorders such as tracheal and bronchial stenosis.
Our physician team includes interventional pulmonologists, thoracic surgeons, ear/nose/throat specialists, speech pathologists, anesthesiologists, radiologists, respiratory therapists, physical therapists, and nurses.
Conditions we treat
Our Complex Airway Program treats patients with a variety of disorders that affect breathing and may cause wheezing, shortness of breath, and other symptoms. These disorders may be inborn, develop after injury or cancer, or occur after treatment for another problem. We have significant experience in performing surgical procedures to treat complex airway conditions.
Tracheobronchomalacia
Normally the central airways (the trachea and bronchi) remain open when you breathe. In TBM, the airways become weak and floppy, tending to collapse with breathing. TBM is a rare condition, and often misdiagnosed. We are among the world leaders in treating TBM. To learn more, read about our
TBM Program.
Tracheal stenosis
The trachea, or windpipe, extends from the voice box to the lungs. Tracheal stenosis involves the narrowing of the windpipe, causing wheezing, coughing, or trouble breathing. Some people are born with tracheal stenosis, while others may develop the problem after infection, injury, or as a result of an underlying disease such as cancer or an autoimmune disorder.
Tracheal or bronchial tumor
Tumors that grow in the windpipe (trachea) or airways (bronchi) can make it hard to breathe. If the tumors grow large, they may block these passages completely. Tumors can be benign or cancer. Our multidisciplinary team can help determine what type of tumor you have and how best to treat it.
Tracheoesophageal fistula
A tracheoesophageal fistula is an abnormal connection (fistula) between the windpipes (trachea) and the esophagus (the passageway that extends from your throat to your stomach). Sometimes people are born with this type of fistula. At other times, it develops after surgery for another problem.
Tracheostomy-related problems (granulation tissue, stoma issues)
A
tracheostomy is a procedure that creates an opening in the neck to access the trachea. This procedure is done to help people breathe. Doctors insert a T-tube into the tracheostomy and into the trachea. A
T-tube is an airway stent shaped liked the letter “T.” This tube provides support for the airways while enabling someone to breathe through a tracheostomy.
When the T-tube is in place, air enters the airways through the tube rather than through the mouth or nose. A tracheostomy may be temporary or permanent, depending on the reason it is performed.
Tests you may have include:
Bronchoscopy
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bronchoscopy is a diagnostic test that enables your doctor to better examine your airways and lungs. To perform the test, the doctor uses a bronchoscope, a device that combines a thin flexible tube with a small light and camera. While you are sedated, the doctor threads the bronchoscope through your mouth or nose, down your windpipe (trachea), and into the branches (bronchi) of your lungs. The camera transmits images to a computer so that the doctor can view snapshots of the tissue inside your airways and lungs.
Pulmonary function tests
Pulmonary function tests measure how well your lungs work. Some tests measure lung size and air flow, such as spirometry and lung volume tests. Others measure how well gases such as oxygen get in and out of your blood. These tests include pulse oximetry and arterial blood gas tests.
Dynamic airway CT scan
During a CT scan, you lie very still on a table while multiple x-rays are taken of your throat and upper chest. A computer assembles these images to provide a detailed view of your airways. In a dynamic airway CT scan, the technician will capture images of your airways as you breathe.
Treatments we offer include:
Airway stent
An
airway stent is a hollow tube that is placed in the airway and used to treat a variety of lung and breathing disorders. These can be placed in a minimally invasive way, during bronchoscopy.
T-tube
A
T-tube is an airway stent shaped liked the letter “T.” This tube provides support for the airways while enabling someone to breathe through a tracheostomy. When the T-tube is in place, air enters the airways through the tube rather than through the mouth or nose. A tracheostomy may be temporary or permanent, depending on the reason it is performed.
Bronchial dilation
This is a noninvasive procedure that uses a flexible bronchoscope fitted with a balloon, which is inflated to open the airways and make breathing easier.
Tracheal or bronchial resection and reconstruction
Some complex airway problems are treated with surgery known as tracheal or bronchial resection and reconstruction. This surgery involves removing (resecting) a small section of the windpipe or bronchi and reconnecting the remaining tissue (reconstruction).
Tracheoplasty
If the narrowing involves a longer section of the windpipe, your doctor may recommend another type of surgery, known as tracheoplasty. The surgeon performs an operation to make the windpipe larger and make it easier to breathe. During surgery, the trachea is divided in the front and back, and narrow portions on both sides are removed. The surgeon then slides the lower portion upwards and reconstructs the trachea, so that it is much wider.
Carinal Resection and Reconstruction
The carina is a medical term for where the windpipe (trachea) meets the two major airways (bronchi) to form an upside-down Y. This tracheobronchial angle, or carina, may require surgery if you have a tumor or another obstruction.
Carinal resection involves removing diseased tissue at this juncture. Reconstruction involves rebuilding the juncture so that you can breathe on your own. Carinal resection and reconstruction is a complex surgery that involves a long recovery.
Repair of tracheoesophageal fistula
Surgery to repair a tracheoesophageal fistula involves making an incision into the side of the chest between the ribs. The surgeon then closes the opening (fistula) between the esophagus and windpipe. The surgeon then connects the upper and lower sections of the esophagus.
Revision of tracheal stoma
A tracheal stoma is an opening in the throat that enables someone to breathe while your upper airway heals. Often a tracheostomy tube is placed in the hole. After the tube is removed (decannulation), you may require revision surgery to ensure that the airways are strong enough to support breathing and to reduce the amount of scar tissue from the stoma.
