Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-27T03:43:23.742Z Has data issue: false hasContentIssue false
  • English
  • Français

Duration of stenting with Montgomery T-tubes in severe laryngotracheal stenosis: does it matter?

Published online by Cambridge University Press:  19 November 2021

M Muraleedharan ,
A S Ramavat ,
J Bakshi ,
S Mohindra ,
G Nayak  and
A Goel
M Muraleedharan
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
A S Ramavat*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
J Bakshi
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
S Mohindra
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
G Nayak
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
A Goel
Affiliation:
Department of Medicine, Dr B R Ambedkar State Institute of Medical Sciences, Sahibzada Ajit Singh Nagar, India
*
Author for correspondence: Dr A S Ramavat, Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh160012, India E-mail: ramavatanu@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Laryngotracheal stenosis management remains largely discretionary in surgical practice. Duration of stenting remains variable following open reconstruction procedures in absence of clearly established differences. The current study evaluates successful decannulation after short-term periods compared with longer periods.

Method

A comparative study over 18 months evaluated differences in successful decannulation between short- and long-term stent groups. Patients with grade II, III or IV laryngotracheal stenosis were placed on Montgomery T-tube for a short-term period (n = 15), and decannulation rates were compared with age-, sex- and diagnosis-matched patients (n = 15) from historical cases with long-term stent placement.

Results

Thirty patients were included. There was no difference between the two groups at baseline. Nine patients (30 per cent) were successfully decannulated, and there was no difference in rates of decannulation between the two groups (p = 0.8). Granulations at the proximal end of tube (38.7 per cent), superior migration of tube (16.1 per cent) and dysphonia (12.9 per cent) were common complications.

Conclusion

Decannulation was not more successful after placing Montgomery T-tubes for longer periods of time when compared with removal within the first three months. Early removal after proper case selection and planning may be considered for a successful outcome in laryngotracheal stenosis.

Keywords

StenosisTracheostomyStents
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 4 , April 2022 , pp. 354 - 359
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A S Ramavat takes responsibility for the integrity of the content of the paper

References

Clément, P, Hans, S, de Mones, E, Sigston, E, Laccourreye, O, Brasnu, D. Dilatation for assisted ventilation-induced laryngotracheal stenosis. Laryngoscope 2005;115:1595–810.1097/01.mlg.0000172040.02154.00CrossRefGoogle ScholarPubMed
Lewis, S, Earley, M, Rosenfeld, R, Silverman, J. Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis. Laryngoscope 2017;127:191–810.1002/lary.26151CrossRefGoogle ScholarPubMed
Wahidi, MM, Ernst, A. The Montgomery T-tube tracheal stent. Clin Chest Medicine 2003;24:437–4310.1016/S0272-5231(03)00042-XCrossRefGoogle ScholarPubMed
Saghebi, SR, Zangi, M, Tajali, T, Farzanegan, R, Farsad, SM, Abbasidezfouli, A et al. The role of T-tubes in the management of airway stenosis. Eur J Cardiothorac Surg 2013;43:934–910.1093/ejcts/ezs514CrossRefGoogle ScholarPubMed
Chen, EY, Inglis, AF Jr. Bilateral vocal cord paralysis in children. Otolaryngol Clin North Am 2008;41:889–90110.1016/j.otc.2008.04.003CrossRefGoogle ScholarPubMed
Nouraei, SA, Ma, E, Patel, A, Howard, DJ, Sandhu, GS. Estimating the population incidence of adult post-intubation laryngotracheal stenosis. Clin Otolaryngol 2007;32:411–210.1111/j.1749-4486.2007.01484.xCrossRefGoogle ScholarPubMed
Holinger, PH, Kutnick, SL, Schild, JA, Holinger, LD. Subglottic stenosis in infants and children. Ann Otol Rhinol Laryngol 1976;85:591–910.1177/000348947608500505CrossRefGoogle ScholarPubMed
McWhorter, AJ. Tracheotomy: timing and techniques. Curr Opin Otolaryngol Head Neck Surg 2003;11:473–910.1097/00020840-200312000-00012CrossRefGoogle ScholarPubMed
Ozkul, Y, Songu, M, Ozturkcan, S, Imre, A, Erdogan, N, Ates, D et al. Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes. Acta Otolaryngol 2016;136:933–610.3109/00016489.2016.1170877CrossRefGoogle ScholarPubMed
Bitoh, Y, Okata, Y, Tsugawa, J, Tsugawa, J, Miyauchi, H, Aida, Y et al. Anterior-posterior cricoid split combined with silastic T-tube stenting for subglottic stenosis in children: a single surgeon's experience. Pedaitr Surg Int 2018;34:1041–610.1007/s00383-018-4328-zCrossRefGoogle ScholarPubMed
Ciccone, AM, De Giacomo, T, Venuta, F, Ibrahim, M, Diso, D, Coloni, GF et al. Operative and non-operative treatment of benign subglottic laryngotracheal stenosis. Eur J Cardiothorac Surg 2004;26:818–2210.1016/j.ejcts.2004.06.020CrossRefGoogle ScholarPubMed
Monnier, P. Laryngotracheoplasty and laryngotracheal reconstruction. In: Monnier, P, ed. Pediatric Airway Surgery. Berlin, Heidelberg: Springer; 2011:257–7710.1007/978-3-642-13535-4_19CrossRefGoogle Scholar
Smith, DF, de Alarcon, A, Jefferson, ND, Tabangin, ME, Rutter, MJ, Cotton, RT et al. Short- versus long-term stenting in children with subglottic stenosis undergoing laryngotracheal reconstruction. Otolaryngol Head Neck Surg 2018;158:375–8010.1177/0194599817737757CrossRefGoogle ScholarPubMed
Jethwa, AR, Hasan, W, Palme, CE, Makitie, AA, Espin-Garcia, O, Goldstein, DP et al. Cricotracheal resection for adult subglottic stenosis: factors predicting treatment failure. Laryngoscope 2020;130:1634–910.1002/lary.28273CrossRefGoogle ScholarPubMed