Airway Management

The Team

Physician - Dr. Charles Bower*(pictured at right with a

patient) and the pediatric otolaryngologists at ACH are
experts in the diagnosis and surgical management of
pediatric airway problems. Dr. Bower is a graduate of the
University of Arkansas for Medical Sciences College of
Medicine, where he also completed a residency in
otolaryngology. Next, he completed a fellowship in pediatric
otolaryngology at Cincinnati Children’s Hospital where
management of airway problems was emphasized. He has
been on the medical staff at ACH for over 10 years where he
has managed all pediatric airway problems from the simple
to the severe and life threatening.

Specialty Nurses - The specialty nurses at ACH are critical for management of children
with airway problems. They are important for the continuum of patient care, education of
caregivers and families, and development and dispensation of hospital policy.

Respiratory Therapy - The respiratory therapy department consists of highly skilled

individuals trained in the management of the most difficult airway and pulmonary
problems.

Anesthesia - ACH has a team of highly-trained pediatric anesthesiologists skilled in the

very delicate challenge of providing anesthesia for critically ill infants and children.

The Hospital - With state of the art equipment, ACH is an entire hospital dedicated to
care, love and hope for children in Arkansas.

Types of Problems

Airway problems are the most important cause of labored breathing in children and occur
on a daily basis. Croup, or airway swelling from infection, can usually be treated
medically. Scarring of the larynx, or masses such as papilloma, require surgical excision,
often performed by highly accurate laser surgery. Some children require open
reconstruction of the larynx or trachea, rebuilding the delicate structures with cartilage
from the rib or ear. Surgery on the nose, palate, tonsils and adenoids, or other areas may
be helpful for airway function.

Subglottic stenosis is a narrowing of the airway which may have been present at birth or
acquired after birth. Treatment is almost always surgical.

Laryngomalacia is an intermittent collapse of laryngeal structures which allows the

airway to briefly close causing noisy breathing. Most infants are managed with
medications, while a small percent require surgery to prevent collapse of the airway.

Tracheomalacia is a softening of the trachea so that the trachea rings are not able to keep
the airway from collapsing on itself, especially during expiration. Surgery is needed in a
small number of cases.

Papilloma is a recurring wart growing on the vocal cords, caused by human papilloma
virus. Surgery is needed for removal of the warts. Medical therapy is used in some cases.
Research is being performed to improve management of children with papillomas.

Vocal cord paralysis is most frequently the result of damage to the nerves of the vocal
cords. Surgery is sometimes needed to improve voice and help children breathe better.

Obstructive sleep apnea is a breathing problem occurring while the upper airway is
blocked during sleep which causes brief pauses in breathing during sleep. This can be due
to many factors such as: facial structure, airway anatomy, muscle tone and large tonsils
and adenoids which can make the airway narrow. Comprehensive diagnostic services are
available if necessary. Most patients can be cured surgically. Non-surgical alternative
such as CPAP (continuous positive airway pressure) are used in some patients.

Choanal atresia is an unusual complete obstruction of the back part of the nose which
causes life threatening airway obstruction in infants. Urgent surgery is life-saving. The
team at ACH is capable of performing state-of-the-art endoscopic surgery in these young
infants.

Pierre Robin Sequence, an unusual variant of cleft palate, is also a life threatening airway
problem in infants. Again, the team at ACH provides expert care for these children,
drawing in skilled nurses, respiratory therapists, and physicians for management without
surgery, in most cases. Advanced surgical techniques are available for the severely
affected children which need the most help.

Diagnostic Tools

X-rays are a painless way to allow a picture of a specific site to be made for the doctor to
observe and evaluate.

CT scans and MRIs are a way for the doctor to see multiple views of a specific site.
Nasopharyngeal endoscopy is a way for the doctor to see the anatomy of the airway
briefly during a regular office visit. To begin, numbing drops are placed in the nostrils.
Then, the soft, flexible tubing with a camera is placed in the nose and gently lowered into
the airway. This often allows not only for the physician to see, but allows a chance to
replay and explain what is seen to the caregivers accompanying the patient to the clinic.

A polysomnogram, or sleep study, is a painless test that examines a person’s sleeping

behavior. During this all-night procedure, several electrodes are applied to the scalp, chin,
chest and legs. An elastic belt is placed around the abdomen. Two thin wires are placed
near the mouth and a small device is placed on a finger.
Following the test, the patient returns to normal activities. The study is analyzed by
technologists and doctors specifically trained in sleep disorders. The results will assist the
doctor in diagnosing sleep and airway problems.

Surgical Interventions

Microlaryngoscopy and bronchoscopy are surgical procedures performed under general

anesthesia. This allows the surgeon to look directly through the mouth at the complete
airway without making an incision. Frequently, laser treatment, surgical repair, or
dilation can be done during the procedure.

Epiglottoplasty is an endoscopic procedure performed by endoscopes for the treatment of

laryngomalacia. The floppy obstructing tissue is
removed with lasers and scissors to open the airway in affected infants.

Laser surgery is also performed endoscopically to open scarred areas, remove masses or
otherwise treat abnormal tissue. Lasers are incredibly accurate, bloodless cutting-tools
which can safely open abnormal airways even in the smallest of infants.

Reconstructive surgery is sometimes needed to repair extremely damaged airways. Open

surgery is performed frequently using grafts of rib or ear cartilage to rebuild narrow
airways.

Tonsillectomy and adenoidectomy is the most commonly performed surgery for sleep
apnea, and provides a very high cure rate. In more severely affected children, removal of
the palate and part of the tonsil pillars (UPPP), tongue surgery (Repose), and other
procedures are necessary for sleep apnea.

Tracheostomy, in which a breathing tube is inserted directly through the skin of the neck,
is a life-saving procedure required for children with the most severely abnormal airways.
Fortunately, the procedure is technically reversible, although airway reconstruction may
be necessary before the tracheotomy can be removed. Postoperative education is an
important component of the safe management of children with a tracheotomy, a service
which is offered by the pediatric otolaryngology specialty nurses.
Contact Info/Referrals
ENT Clinic: 501-364-1225
ENT Office: 501-364-1047

*Dr. Charles Bower, chief of otolaryngology, ACH, associate professor, UAMS.

Arkansas Children's Hospital, 1 Children’s Way, Little Rock, AR 72202-3591, (501) 364-1100 or TDD (501) 364-1184

Web Site Feedback Survey | ACH is a tobacco free campus.

Joint Notice of Privacy Practices | Terms & Conditions of Use | Report Concerns
About Patient Care & Safety | Site Index

About ACH | Your Visit to ACH | Community Outreach Programs

Medical Services | Career Opportunities | Volunteer Opportunities
ACH Foundation | Press Room | Resources | Research | Kids Only | Contact Us