Role of Montgomery T-tube in laryngotracheal stenosis

Abstract

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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 3<sup>rd</sup> 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%).</p><p><strong>Conclusions:</strong> 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. </p>

Evolution in the Management of Laryngotracheal Stenosis

“…Commonest cause of LTS being iatrogenic, secondary to ICU intubation or tracheostomy [6][7][8][9][10] . The incidence of iatrogenic LTS is likely to be increasing as the survival rates following ICU intubation improve with the improvement of ICU care 11,12 .…”