Surgical management of obstructive diseases of the pediatric airway is challenging and rewarding. These diseases may present with acute, life-threatening airway obstruction and warrant quick relief of obstruction often accomplished by endotracheal intubation or tracheotomy. The etiology of obstructive airway disease is often multifactorial, and includes anatomic, congenital, and inflammatory problems. Regardless of the cause and mode of presentation, diagnosis and successful surgical management requires a high index of suspicion and clinical experience to establish the correct diagnosis and formulate a surgical solution. To achieve good surgical outcomes, meticulous attention to detail, recognition and treatment of other medical comorbidities that affect healing, and complete dedication of the surgeon's time and resources are required. These resources include many other pediatric specialists and other allied health care individuals. The priority of intervention is to establish and maintain a safe and stable airway. One must also recognize that diseases causing airway obstruction and the surgical interventions to correct these problems may compromise voice, speech, and swallowing. The impact of these diseases and their surgical interventions may have tremendous socialization implications for children at a critical phase of growth and development. Because of the potential impact and devastating outcomes these diseases and interventions may have on medical and psychosocial development of children, we are obliged to examine our interventions to assume the best possible outcomes for airway, voice, swallowing, and socialization. The number of children who require surgical intervention for airway obstruction has increased.