Tracheomalacia describes the collapsibility of an airway. It’s a complicated disease, and is often misdiagnosed because it’s felt to be so uncommon that when you have noisy breathing they’ll be thinking of something else like croup, or asthma rather than thinking of airway collapse or tracheomalacia as part of the problem. Tracheomalacia can cause noisy breathing, so a very loud cough, recurrent infections, and even worse, recurrent pneumonias that cause damage to the lungs and the airways. Right here’s my breastbone, and behind that, all the way in the back, is my spine. And in here, are different structures. In general, there’s the esophagus, then the trachea, then the blood vessels, and then a thymus gland, and then the sternum. So you have a little sandwich, and if that space is too narrow, something’s got to give. The trachea’s only going to squish so much. How do you get more room out of that sandwich? That is the essence of treating tracheomalacia. Tracheomalacia really comes in three very broad categories. The most common type that we see is when you have normal cartilages, but instead of being a C-shape, you have a U-shaped or even a bow-shaped cartilages. Now they’re just as strong, but the membrane on the back is very flexible, so when you exhale, that membrane goes up and touches the front of the cartilages, and collapses all the way in. That’s the easiest type to treat and fortunately the most common type. The second most common type is where things are shifted slightly, and instead, the blood vessel on top, say the innominate artery, has been leaning on it. Now you have an airway that’s considerably smaller when you’re breathing in, and when you breathe out, it gets even more narrow. The third type, which is less common and more severe, is associated with cardiac disease where things didn’t develop right. Two aortic arches, one on either side of the trachea, squish it, so it’s now half or a third of the size, or you have an abnormal blood vessel squishing it from the back. Boston Children’s is the perfect place for innovation in this field. Our familiarity with that fine detailed anatomy and these babies really allows us to become innovative when we have a challenge that nobody else has been able to solve. In the next video, I’ll talk about treatment options for each of these types of tracheomalacia.