Montgomery T-tube placement for subglottic tracheal stenosis failed in three cases and literature review

Abstract

Objective To analyze clinical features of three patients with Cotton-Myer grade Ⅲ-Ⅳ subglottic tracheal stenosis who failed in Montgomery T-tube placement therapy, for a better understanding of indications and contraindications of the therapy. Methods Three patients with failed in T-tubes placement for subglottic tracheal stenosis admitted in Beijing Tiantan Hospital within recent four years were included in this study.The etiology, clinical features, placement of T-tube procedures, placement complications, treatment measures, and potential causes of T-tube placement failure were summarized, and corresponding literatures were reviewed. Results Among the three patients, two patients were male, aged between 48-74 years old, and all the three cases were confirmed subglottic tracheal stenosis after tracheotomy.The Cotton-Myer grade Ⅲ-Ⅳ stenosis were presented at 52 months, 1.5 months and 5 months after tracheotomy, respectively.For treatment, 12 mm T-tubes were placed in all three cases, with the distance between the T-tube upper edge to glottis as 15 mm, 8 mm and 5 mm, respectively.Postoperative complications included three cases of granulation hyperplasia on the upper edge of the T-tube, two cases of glottic edema, one case of severe secretion retention, and one case of fever.The patients underwent multiple bronchoscopy to clean proliferative granulation in the upper branch of T-tube and local cryotherapy for 4, 6 and 7 times, respectively.However, all three patients suffered from blocked ventilations due to granulation hyperplasia in the upper edge of the T-tube, largely caused by the suboptimal trachea-T-tube angle, scar physique, hypertrophy and edema in the peri-glottis and subglottic mucosa.Finally, T-tubes were removed on the 8th, 15th, and 30th days after placement, respectively. Conclusions The feasibility of T-tube placement for subglottic tracheal stenosis patients who have airway distortion, scar physique, limb and sustained swallowing dysfunction which are often caused by craniocerebral diseases needs further studies to evaluate. Key words: Subglottic; Stenosis; Montgomery T-tube; Complication