Airway Disorders Center
For Referring Providers
To Refer A Patient Please Call:
Dr. Marshall Smith
Dr. Mark Elstad
We look forward to providing you with an array of airway services and working closely with your practice. For additional questions or further consultation please call: 801-587-3549.
About our clinic:
The Airways Disorders Center at University of Utah Hospital offers a novel multidisciplinary approach to the evaluation and treatment of airway diseases. Comprehensive care for patients with benign and malignant diseases of the central airways from the pharynx and larynx through the large airways within the chest is offered, including a complete range of open and endoscopic surgical approaches in the management of airway obstruction. The center resulted from a longstanding informal collaboration between two airway management specialists, Marshall Smith, MD, associate professor of otolaryngology/head and neck surgery, and Mark Elstad, MD, professor of internal medicine, pulmonary division. The complementary skills of a laryngologist and an interventional pulmonologist are ideally suited to the management of complex airway disorders. Other specialists that participate in the care of these patients include: cardiothoracic surgery, hematology/oncology, radiology oncology, radiology, rheumatology, sleep medicine, gastroenterology, pulmonary rehabilitation, and speech pathology.
Patients with all forms of malignant and benign central airway diseases are treated at the center. The central airways include the larynx, trachea, and intrathoracic airways that are accessible via the bronchoscope. Primary and metastatic malignancies are treated with both curative and palliative modalities. Benign stenoses include those caused by trauma (intubation, tracheotomy), systemic diseases (Wegener’s granulomatosis, amyloidosis, papillomatosis), and thermal injury. Idiopathic subglottic stenosis and other disorders of unknown cause are seen. Patients with tracheotomy and difficult airway problems are commonly seen, as efforts are made to decannulate the tracheotomy.
The team approach to evaluation and management allows for flexibility in treatment, ranging from endoscopic to open procedures. Center visits usually involve the patient undergoing flexible laryngoscopy and bronchoscopy to examine the airway lesion. A technique used by Smith and Elstad allows for larynx, trachea, and bronchi to be examined with the patient awake and unsedated, using only topical anesthesia.
Open surgical approaches include operations such as laryngotracheoplasty, tracheal and cricotracheal resection, tracheotomy (temporary or permanent), and a variety of operations to improve laryngeal function. Endoscopic surgeries are performed using suspension laryngoscopy and rigid or flexible broncoscopy. These are routinely combined with dilatation, laser resection, stenting, intraluminal radiation (brachytherapy), photodynamic therapy, and other interventions. Typically, more than one approach may be used for theses diseases. The patient's general health, lifestyle, and personal preferences are carefully considered in recommendations regarding surgical approaches. Non-surgical approaches to the management of central airway disorders, such as pulmonary rehabilitation and voice therapy, play an important role in improving the quality of life for such patients.
The University of Utah physicians have active research projects, both in the center and in the basic science laboratory. Clinical studies in the Airway Disorder Center are ongoing to determine the effect of topical mitomycin c on recurrence of airway stenosis, to determine the mechanisms for dyspnea in patients with airway obstruction, and to objectively compare the outcome of different surgical approaches. Thus, the center represents the clinical arm of a bench-to-bedside program. Theses physicians are dedicated to the development of new therapies and improvement in application to old ones.