Role of Montgomery T-tube in laryngotracheal stenosis
Keywords:Laryngotracheal stenosis, Montgomery T-tube, Prolonged intubation
Background: The purpose of this retrospective study was to evaluate the outcome of laryngotracheal stenosis in patients undergoing Montgomery T-tube insertion in our institution. This study also throws light on the indications and complications of Montgomery T-tube insertion.
Methods: 39 patients who presented with laryngotracheal stenosis in the Department of Otorhinolaryngology at the JSS Medical College, Mysore, India during period of January 2012-December 2015.Out of which, 32 patients underwent stenting by Montgomery T-tube through an external approach. The follow-up period ranged from 6-24 months.The T-tube was removed after a minimum period of 6–12 months.
Results: The most common cause of laryngotracheal stenosis was prolonged intubation as seen in 89.7% patients, majority of patients (41%) in this study were in the 3rd decade. In this study all the patients underwent tracheostomy prior to treatment for stenosis. Out of 32 patients, decannulation was not possible in four (12.5%). The most common complication seen was surgical emphysema in 21 patients (50%) followed by crusting in 13 patients (40.6%), granulations at the upper of end in 1 patient (3.1%), and granulations around the stoma in 4 patients (12.5%).
Conclusions: Laryngotracheal stenosis (LTS) has always been and will remain a challenge to the otolaryngologist and a multidisciplinary approach is required to tackle it. Stenting remains a relatively conservative treatment, is successful in a proportion of cases. Although there are complications associated with the T tube it is always easily manageable and are not usually life threatening.
Menard M, Laccourreye O, Brasnu D, Laccourreye H. Sténoseslaryngées de l’adulte. In: Edition Technique, Encycl Med Chir. 6th edition. Paris: 1990: 1–8.
Thawley SE, Ogura JH. Panel discussion: the management of advanced laryngotracheal stenosis. Use of the hyoid graft for treatment of laryngotracheal stenosis. Laryngoscope. 1981;91:226–32.
Herrak L, Ahid S. Tracheal stenosis after intubation and/or tracheostomy. Egypt J Chest Dis Tuberc. 2014;63:233-7.
Montgomery WW. Silicone tracheal T-tube. Ann Otol. 1974;83:71–5.
Oliverio AJ, Sprinkle PM. Treatment of post-intubation and cuffed tube tracheal stenosis with T-tube tracheal stent. West Virginia Med J. 1973;69:27–8.
Gaissert HA, Grillo HC, Mathisen DJ, Wain JC. Temporary and permanent restoration of airway continuity with the tracheal T-tube. J Thorac Cardio vasc Surg. 1994;107(2):600–6.
Mandour M, Remacle M, Van de Heyning P, Elwany S, Gaafar ATA. Chronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction. Eur Arch Otorhinolaryngol. 2003;260:374–80.
Kumar SP, Ravikumar A, Senthil K, Somu L, Nazrin MI. Role of Montgomery T-tube stent for laryngotrachealstenosis. Auris Nasus Larynx. 2014;41(2):195-200.
George M, Lang F, Pasche Ph, Monnier Ph. Surgical management of laryngotrachael stenosis in adults. Eur Arch Otorhinolaryngol. 2005;262:609–15.
Zalzal GH, Cotton RT. Glottic and subglottic stenosis. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, editors. Otolaryngology-head and neck surgery. 2nd edn. St. Louis: Mosby-Year Book; 1993: 1981–2000.
Grillo HC, Zannini P, Michelassi F. Complications of tracheal reconstruction. Incidence, treatment, and prevention. J Thorac Cardiovasc Surg. 1986;91:322-8.
Hanna E, Eliachar I. Endoscopically introduced expandable stents in laryngotracheal stenosis: the jury is still out. Otolaryngol Head Neck Surg. 1997;116:97–103.
Eliachar I, Goldsher M, Alder O. Combined treatment of concurrent laryngeal and tracheal stenosis. J Laryngol Otol. 1981;9:59–66.
Andrews MJ, Pearson FG. Incidence and pathogenesis of tracheal injury following cuffed tube tracheos- tomy with assisted ventilation. Ann Surg. 1971;173:249-63.
Cooper JD, Grillo HC. The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. Ann Surg. 1969;169:334-48.
Grillo HC, Cooper JD, Geffin B, Pontoppidan H. A low pressure cuff for tracheostomy tubes to minimize tracheal injury: a comparative clinical trial. J Thorac Cardiovasc Surg. 1971;62:898-907.
Colt HG, Dumon JF. Airway stents: present and future. Clin Chest Med. 1995;16(3):465–78.
Kurrus JA, Gray SD, Elstad MR. Use of silicone stents in the management of subglottic stenosis. Laryngoscope. 1997;107(11):1553–8.
Zalzal GH. Use of stents in laryngotracheal reconstruction in children: indications, technical considerations, and complications. Larygnoscope. 1988;98(8):849–54.
Morris DP, Malik T, Rothera MP. Combined ‘trache-stent’: a useful option in the treatment of a complex case of subglottic stenosis. J Laryngol Otol. 2001;115(5):430–3.
Whitehead E, Salam MA. Use of the carbondioxide laser with the Montgomery T-tube in the management of extensive subglottic stenosis. J Laryngol Otol. 1992;106(6):829–31.