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      A Novel Insertion Technique for the Extra-Long Montgomery T-Tube in Patients with a Large Mediastinal Tumor

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          Abstract

          The Montgomery T-tube is widely used to stent airway stenotic diseases. Conventional insertion methods can sometimes fail in the case of long-distance subglottic stenosis due to the flexibility of a T-tube made of silicon, which kinks when forced against resistance. Therefore, an alternative approach can assist in the insertion of an extra-long T-tube, especially when using a long proximal limb. We report herein the case of a patient with a large mediastinal tumor caused by neurofibromatosis type 1 in which airway obstruction was avoided through the use of a novel extra-long T-tube placement technique.

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          Use of the silicone tracheal T-tube for the management of complex tracheal injuries.

          This paper reports on the use of the silicone Montgomery T-tube for the management of 18 patients with complex tracheal injuries. Our use of the tube was as follows: prior to definitive resection, as a better alternative to tracheostomy tube, while we were awaiting the most appropriate time for resection; at the time of resection, as an adjunct to segmental subglottic resection, used to stent residual abnormal laryngeal mucosa: following tracheal resection for uncertain or unsatisfactory healing: as sole treatment, when resection was deemed unsuitable or inappropriate. When stenting the high region, the upper limb of the T-tube can be brought through the vocal cords with preservation of a functional voice and without injury to the vocal cords even with prolonged use. In contrast to a tracheostomy tube, the T-tube provides respiration through the the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free, requires little if any maintenance, and can remain in place for a year or more when necessary.
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            Total Cervical Tracheal Stenosis: Treatment by Laser, Dilation, and Stenting

            Twelve patients with total cervical tracheal stenosis were treated by endoscopic laser excision (neodymium:yttrium aluminum garnet or carbon dioxide laser), bronchoscopic dilation, and prolonged stenting with a silicone T-tube. All patients had previous traumatic or prolonged endotracheal intubation requiring a tracheotomy and presented with aphonia as the major complaint. Multiple laser and dilation treatments were necessary in ten patients. Average duration of T-tube placement was 6 months. Excellent results (decannulation and good voice) were achieved in eight patients with a follow-up of 9 months to 6 years. Persistent granulation tissue and some degree of fibrosis were the most common complications (eight of 12 patients). Two patients died of medical complications. A high success rate with this endoscopic technique justifies this approach as our initial therapy, with open surgical techniques reserved for failure.
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              Subglottic Stenosis Above Tracheal Stoma: Technique for Montgomery T -Tube Insertion

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                Author and article information

                Journal
                Ann Thorac Cardiovasc Surg
                Ann Thorac Cardiovasc Surg
                atcs
                Annals of Thoracic and Cardiovascular Surgery
                The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery
                1341-1098
                2186-1005
                1 August 2020
                2020
                : 26
                : 5
                : 294-297
                Affiliations
                [1]Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
                Author notes
                Corresponding author: Tatsuya Kato, MD, PhD. Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
                Article
                atcs.nm.20-00128
                10.5761/atcs.nm.20-00128
                7641885
                32741884
                4bf23166-a9f8-459c-b42e-c9d53c47e770
                ©2020 Annals of Thoracic and Cardiovascular Surgery

                This work is licensed under a Creative Commons Attribution-NonCommercial-NonDerivatives International License

                History
                : 11 May 2020
                : 25 May 2020
                Categories
                New Method

                montgomery t-tube,airway management,tracheal stenosis

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