Montgomery T-tube Research Articles

Application of Montgomery T-tube implantation after reverse puncture airway recanalization in the treatment of Cotton-Myer Ⅳ subglottic airway atresia

Cotton-Myer Ⅳ subglottic airway atresia is the most severe type of tracheal stenosis, often leading to long-term in-dwelling tracheotomy cannula in patients, which can severely affect their quality of life and even be life threatening. In order to improve the treatment ability of bronchoscopy physicians for airway atresia, this article retrospectively analyzed 10 cases of subglottic airway atresia in Beijing Tiantan Hospital, Capital Medical University, and summarized the experience of achieving better results by Montgomery T-tube implantation after reverse puncture airway recanalization.

Unveiling the safety landscape: A comprehensive review of the toxicological profile of facial aesthetic implants and biomaterials

Exploring diverse biomaterials and implants in the ear, nose, and throat by understanding adverse effects and post-usage events. Literature was obtained from Scopus, PubMed, Google Scholar, and Web of Science. A comprehensive analysis was conducted on original research studies, case reports, and case series spanning from December 2010 to May 2022. Our analysis underscores that the effectiveness of cochlear implants (CIs) relies on factors such as biocompatibility, anti-inflammatory measures, and fibrosis reduction. Although silicone is employed in otologic applications, allergic reactions leading to CI extrusion are rare. In the context of partial ossicular replacement prostheses or total ossicular replacement prostheses, polyethylene grafts (Teflon) are utilized, and Nitinol-pistons are employed in stapedotomy, with adverse consequences encompassing graft extrusion and residual perforation. Chronic sphenoid sinusitis is linked to the use of Medpor porous polyethylene implants in sellar reconstruction during skull-based surgeries. Injectable collagen preparations in vocal cord paralysis lead to submucosal deposits and resultant dysphonia. Montgomery T-tubes are employed for subglottic stenosis but are associated with granulation tissue formation. Metallic tracheostomy tubes give rise to secondary foreign bodies, and double-lumen tracheostomy tubes are prone to biofilm formation. Despite numerous research studies, there remains a necessity for the refinement of implant designs to mitigate complications and enhance the overall quality of life for patients.

Montgomery Tracheal Tube - A Boon with a Challenge

Crico-tracheal resection and anastomosis are commonly used operative techniques in managing crico-tracheal stenosis grade III-IV. The Montgomery T-tube is used both as a tracheal stent and tracheostomy. Still, it poses various challenges to anaesthesiologists, like loss of anaesthetic gases through the open proximal end of the vertical limb and lack of standard anaesthesia circuit connectors. Here we present a case of 27 years old male with a history of gunshot injury to the neck three years ago with right vocal cord palsy with subglottic tracheal stenosis grade IV posted for microlaryngobronchoscopy (MLB) with crico-tracheal resection and anastomosis with Montgomery tracheal tube insertion. In this case, we used LMA proseal, which not only enabled us to stop the anaesthetic gas loss via the proximal vertical limb of the T-tube but also aided in checking airway patency and proper positioning of the T-tube via flexible bronchoscope through it.

Endoscopic recannulation of long-segment, grade IV suprastomal tracheal stenosis: An operative technique

BackgroundLong-segment, grade IV suprastomal tracheal stenosis is rare and difficult to treat (Carpenter et al., 2022 [1]). Patients with grade IV stenosis have significant quality of life impairments since they are tracheostomy dependent and aphonic. Open airway surgery is often needed to improve tracheal patency, restore the patient's voice, and progress towards decannulation (Abouyared et al., 2017 [2]). However, not all patients are candidates for upfront open surgery (Abouyared et al., 2017; Shamji, 2018 [2,3]). Therefore, it is important to develop and refine endoscopic interventions to improve quality of life for these patients. MethodsWe describe a step-by-step endoscopic approach to the recannulation of long-segment, grade IV suprastomal tracheal stenosis. Briefly, our approach utilizes dual (proximal & distal) visualization of the stenosis prior to passing a 25 gauge needle through the stenosis to identify the proper trajectory for recannulation. Then a 16 gauge needle is passed in the same manner, and a wire is placed through the needle and into the distal airway. Once the airway is recannulated, the initial pinpoint opening is gradually widened in Seldinger fashion over the wire with Savary dilators followed by balloon dilation. Finally, a suprastomal L-stent (modified Montgomery T-Tube) is placed to reduce the risk of restenosis (Edwards et al., 2023 [4]). Case discussionA 39-year-old woman with a past medical history significant for poorly controlled type I diabetes mellitus and polysubstance abuse presented with tracheostomy dependence and aphonia. She was diagnosed with a long-segment, grade IV suprastomal tracheal stenosis and initially underwent endoscopic recannulation. This intervention restored her voice and allowed for optimization of her medical conditions before open airway surgery. ConclusionMost patients experience a significant improvement in their quality of life as their voice is typically restored following this procedure. Additionally, individuals who eventually require open airway surgery gain additional time for medical optimization. In our experience, this procedure represents a safe and effective means of extending the utility of traditional endoscopic airway interventions for the management of patients with grade IV stenosis.

Otolaryngology Implants Usage and their Material Adverse Event Profile - A Narrative Review

Objectives:The objective of this study is to review various biomaterials or implants used in ENT and their adverse effects on events that were noticed from the initial days to the present era.Methods:Relevant articles were searched from the databases. PubMed, Scopus, Web of Science, and Google were used to search for the data.Results:Cochlear implant (CI) adequacy depends on biocompatibility, anti-inflammatory treatment, and reduction of fibrosis. Silicone is used in the otologic field, and its allergy is a rare cause of CI extrusion. Nitinol pistons are used in stapedotomy, and polyethylene (Teflon) grafts are used in partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP). Their complications include graft extrusion and residual perforation. Chronic sphenoid sinusitis is associated with Medpor porous polyethylene implants used for sellar reconstruction in skull-based surgeries. In vocal cord paralysis, injectable collagen preparations form submucosal deposits and dysphonia. Montgomery T-tubes are used in subglottic stenosis, and they produce granulation tissue. Metallic tracheostomy tubes cause the formation of secondary foreign bodies, and biofilms appear in double-lumen tracheostomy tubes.Conclusion:Even though several research studies have been carried out, still a modification of implant design is needed to minimize the complications and to further promote the quality of life of patients.

Airway Management of a Patient with Montgomery T-tube in situ undergoing Neurosurgery

This article stipulates the airway management in a patient requiring cranial debridement and cranioplasty with a Montgomery T-tube (MTT) in situ. Anesthetic techniques that have been previously described for surgeries with MTT in situ which can be managed by applying a laryngeal mask or intubating a trachea tube easily. The airway management of patients with an MTT in situ, requiring a supine position with the head rightly tilted and flexed, has not yet been addressed. In this article, we explored some possible approaches to cope with this arising problem. We present how we managed to intubate a double-lumen endotracheal tube onto the superior tracheal limb of the T-tube since the 5.0 mm ID tracheal tube (equivalent to a 6.9 mm ED) could not pass through the tube readily. This technique could possibly be considered for patients in similar clinical scenarios.

Case series: Montgomery T-tube placement for subglottic tracheal stenosis: a report of 3 cases.

Subglottic tracheal stenosis is stenosis of the trachea between the vocal cords and the lower margin of the cricoid cartilage. The Montgomery T-tube is used as a tracheostomy tube and a combined tracheal stent to avoid postoperative tracheal stenosis. Because the stenosis is close to the glottis, surgical treatment is complex, and many complications may arise. Subglottic tracheal stenosis. The patients underwent endotracheal intubation or tracheotomy because of acute pancreatitis, laryngeal malignancy, or cerebral hemorrhage after endotracheal intubation or tracheotomy and presented with varying degrees of tracheal stenosis and dyspnea. We relieved airway stenosis and improved dyspnea in these 3 patients by placing a Montgomery T-tube. None of the 3 patients had intraoperative complications. In 2 of the cases, airway secretions were stored after surgery. Montgomery T-tube placement is safe and effective for patients with complex subglottic tracheal stenosis.

Management of post intubation tracheal stenosis

Background: Postintubation tracheal stenosis (PITS) is caused by a number of etiologies demanding mechanical ventilation and application of endotracheal or tracheostomy tubes which in turn conflict regional ischemic necrosis of the airway at various levels, presenting the characteristic signs and symptoms of airway obstruction. The incidences of PITS have been decreased with the recognition of the causes, and modification of endotracheal tubes and methods of management. Patients and Methods: Fifty four patients were identified between June 2017 and June 2019. Those patients were treated for tracheal stenosis which developed after prolonged endotracheal intubation. The study was done in Cardiothoracic Surgery departments at Kasr-Alainy Hospital (Cairo University). Patients were managed by rigid bronchoscopic dilatation, airway devices (as Montgomery t-tube or metallic stent) and/or primary tracheal resection and end to end anastomosis. Results: Out of the 54 patients: Three (5.5%) were planned for tracheostomy from the start. Fifty-one (94.4%) were subjected to rigid bronchoscopic examination & dilatation. Three patients (5.5%) were fully improved after bronchoscopic dilatation. The rest of the patients (48) were directed to the next stage in our management, either staged management or resection anastomosis.

Montgomery T-Tube Airway Restoration and Swallowing Rehabilitation for a Near-Hanging Female.

Patients who fail to commit suicide by hanging often end up with laryngotracheal injuries, which may lead to a compromised airway, swallowing dysfunction, and dysphonia. Previous studies have mainly focused on airway management after near-hanging attempts. Few have shed light on the treatment of swallowing dysfunction after laryngotracheal injuries. Here, we present a near-hanging patient who developed complete dysphagia shortly afterward. We used a Montgomery T-tube as an endolaryngeal stent, combined with swallowing rehabilitation. The patient's swallowing ability was gradually restored one month after the surgery, and the stent was removed six months later. The present case report exemplifies the unique way of using the Montgomery T-tubes in clinical practice. Among the patients with airway stenosis affecting the larynx and extending to the vocal cords, Montgomery T-tube may be the only stent that can help manage strictures at the level of the vocal cords and in the supraglottic region, restoring swallowing function and maintaining the airway.

Functional outcomes after transoral CO2 laser treatment for posterior glottic stenosis: a bicentric case series

PurposeThe aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I–IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers.MethodsAn observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires.ResultsQuality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of − 31.0 (p = 0.003), the EAT-10 with a median variation of − 4.0 (p = 0.042), and the ADVS with a median variation of − 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy.ConclusionIn conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.

In situ remodeling of Montgomery T-tube: Anesthetic challenges and serendipitous discoveries.

Department of Anaesthesia, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India Address for correspondence: Dr. Mayank Gupta, Department of Anaesthesia, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand - 248 001, India. E-mail: [email protected] Received July 19, 2020 Accepted March 07, 2021 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Voice and Airway Outcomes of Montgomery T-tube Placement in Laryngotracheal Stenosis

To describe voice and airway outcomes and complications experienced by patients with laryngotracheal stenosis following Montgomery T-tube placement. Retrospective chart review of all patients with laryngotracheal stenosis and Montgomery T-tube placement treated at a tertiary referral center from 2012 to 2021. Eighteen patients met criteria with laryngotracheal stenosis, seven including the level of the glottis and 11 without glottal involvement. Eleven were completely aphonic before T-tube placement and the remainder had severe dysphonia. There was improvement of Voice Handicap Index-10, Reflux Symptom Index, and GRBAS grade following T-tube placement in patients compared to their preoperative values. Improvement of grade was greater in patients without glottal involvement. Complications of chronic indwelling T-tube included granulation in 14 patients (78%), tracheitis in two patients (11%), and mucus plugging in three patients (17%) with one T-tube related mortality. Five patients were eventually decannulated, six returned to tracheostomy tube, and seven retained the T-tube at last follow-up (average: 30 months, range: 4-80 months). Montgomery T-tube placement improves voice in patients with severe dysphonia secondary to laryngotracheal stenosis with and without glottal involvement though the degree of improvement is greater in patients without glottal involvement. T-tube can help reestablish long-term laryngotracheal continuity in patients with no other surgical options. The potential benefits in phonation should be weighed against the possibility of rare but serious adverse events.

Emergency Airway Management in a Patient with a T-Tube Tracheal Stent

BackgroundAbnormal anatomy complicates emergency airway management. In this case, we describe definitive airway management in a critically injured emergency department (ED) patient with a history of partial tracheal resection who had a Montgomery T-tube, a type of T-shaped tracheal stent, in place at the time of the motor vehicle collision. The Montgomery T-tube is not a useful artificial airway during resuscitation, as it lacks a cuff or the necessary adapter for positive pressure ventilation. Case ReportWe describe a case of a 51-year-old man who required emergency airway management after a motor vehicle collision. The patient had a Montgomery T-tube in place, which was removed with facilitation by ketamine sedation and topical anesthesia. The patient was successfully intubated through the tracheal stoma after removal of the T-tube. Why Should an Emergency Physician Be Aware of This?Emergency physicians must recognize the Montgomery T-tube, which resembles a standard tracheostomy tube externally, and have some understanding of how to manage a critically ill patient with this rare device in place. When a patient with a Montgomery T-tube in place requires positive pressure ventilation, the device may require emergent removal and replacement with a cuffed tracheostomy or endotracheal tube.

The use of modified Montgomery T-tubes as frontal sinus stents: how I do it.

Frontal sinus surgery is challenging as the frontal recess is prone to re-stenosis and there is subsequent occlusion of the frontal sinus outflow tract. In an attempt to maintain the frontal recess calibre and reduce frontal sinus re-stenosis, frontal sinus stents have been used with different materials and varying results. This paper presents the technique of using a modified Montgomery T-tube as a frontal sinus stent. The use of a soft, self-retaining and non-absorbable stent that can be used for stenting of the frontal sinus is described. Our technique is safe, effective, inexpensive and well tolerated.

Managing subglottic stenosis with Montgomery tube - Our experience.

The purpose of this retrospective study is to evaluate the outcome of Montgomery T-tube insertion in our institution (AIIMS, Raipur). This study also throws light on its indications and complications. This is a retrospective study of 10 patients who presented with laryngotracheal stenosis and managed by Laryngofissure with Montgomery Tube insertion in the Department of Otorhinolaryngology, Head and Neck Surgery atAll India Institute of Medical Sciences (AIIMS) Raipur, India, during the period of January 2018- JUNE 2020. The most common cause of laryngotracheal stenosis was prolonged intubation as seen in 80% patients.Majority of patients (40%) in this study were in the 3rd decade. In this study all the patients underwent tracheostomy prior to treatment for stenosis. The most common complication seen was surgical emphysema in post-operative period seen in 6 patients (60%) followed by crusting in 4 patients (40%), secondary granulation tissue formation in 4 patients (40%). Montgomery tube reinsertion had to be done in 2 patients (20%). Laryngotracheal stenosis (LTS) has always been and will remain a challenge to the otolaryngologistsand a multidisciplinary approach is required to tackle it.A multitude of surgeries have been described for the management of Laryngotracheal stenosis ranging from Endoscopic dilatation and cricotracheal resection with anterior and posterior grafting and anastomosis but many of them require specialized training and expertise,prolonged ICU care and have morbidity and mortality. 'Laryngofissure and Montgomery Tube stenting provides a safe and easy treatment option which can be done at most centres provided appropriate case selection has been done.

Efficacy and safety of Montgomery T-tube placement for benign complex subglottic tracheal stenosis: a retrospective analysis of 29 cases

Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.

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

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. 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. 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. 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.

Ventilating through Mobile and Migrated Montgomery T-tube: an Enigma

Montgomery T-tube used to maintain a patent airway in post tracheostomised patients can act like a double edged sword. We report a case where a T-tube migrated into distal airway leading a precarious situation.

Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization.

Objective The purpose of this study is to explore the effectiveness and safety of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization. Methods This study is a retrospective study. 11 patients who were treated for IV subglottic airway atresia between January 2017 and January 2019 in the Second Affiliated Hospital of Jiaxing University were involved in this study. The 11 patients all had undergone tracheotomies at our hospital, and they were transferred to the Department of Pulmonary and Critical Care Medicine for Montgomery T-tube placement after bi-level airway recanalization when their subglottic airway was atretic. Patients were observed for their clinical manifestations after placement. The effectiveness of T-tube placement after bi-level airway recanalization was assessed. The incidence of short-term and long-term complications after surgery was assessed. Patients were followed up for 3 to 24 months for evaluating their airway recovery. Results T-tubes were successfully placed in 11 patients. The atretic airways of all patients were recanalized after treatment. Eight patients got restoration of vocal ability, and 3 patients could only say simple words. None of the patients needed assisted oxygen inhalation. The SpO2 average level was increased from 95 ± 2% before treatment to 97 ± 3% after treatment. Patients had significant relief of cough or sputum, and they had less difficulty in dyspnea. All short- or long-term complications were self-relieved or controlled without further malignant progression after treatment by doctors. The average postoperative extubating time was (14.86 ± 3.62) months. Conclusion The application of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization is well effective and safe for patients, and it can be promoted in clinical treatment.

Montgomery T-Tube Insertion Under ECMO in a Patient With Complete Subglottic Stenosis and Severe Lower Tracheal Collapse.

The treatment of complete subglottic stenosis (SGS) remains a challenge due to anatomic and technological limitations. Placement of the Montgomery T-tube is an effective treatment option. For complete SGS patient combined with lower trachea collapse, the ventilation management during the T-tube insertion process is more complicated. Here, we report a case with complete SGS combined with severe lower trachea collapse, which was successfully managed with T-tube insertion under extracorporeal membrane oxygenation.