title: Silicone T-tube for complex laryngotracheal problems.
abstract: OBJECTIVE
  The use of a T-tube to manage complex laryngotracheal lesions, such as tracheal stenosis, tracheomalacia and tracheal injury, has previously been reported by other surgeons in the past. However, further validation of clinical details, including operative management and postoperative care, is needed.
  
  
  METHODS
  From January 1991 to May 2000, 53 patients, including 24 with post-tracheostomy stenosis, received 55 silicone T-tubes for transient or permanent stenting of the airway. There were 20 patients for subglottic stenosis; eight for long segment tracheostensis; seven with tracheal stenosis for severe cervicomediastinal fibrosis not amenable for reconstruction; six for complex tracheal injury; four for glottic injury; two each for tracheomalacia, failed tracheal surgery and tuberculotic tracheostenosis; and one each for tracheo-esophageal fistula and necrotizing tracheitis. We retrospectively analyzed these patients.
  
  
  RESULTS
  Thirty-eight out of 53 patients (71.8%) with T-tube stenting from 3 to 15 months was considered successful. Fifteen patients' operations failed due to patients' underlining diseases, previous intractable pulmonary infection, poor cognition and/or inadequate tube position. After removal of the tube, three patients (10.7%) developed partial airway obstruction with mild subglottic granulation tissue, which was resolved by carbon dioxide laser therapy. Two patients (7.1%) with prolonged tracheocutaneous fistula were conservatively treated by silver nitrate.
  
  
  CONCLUSIONS
  Silicone T-tube can effectively resolve the complex laryngotracheal lesions with limited complications. Concurrent cardiopulmonary diseases and intractable infection were the two major causes for failure after the T-tube reconstruction.
authors.affiliation: Division of Thoracic Surgery, Mackay Memorial Hospital, #92, Sec 2, Chung-San N. Road, Taipei, Taiwan. hcliu@ms2.mmh.org.tw
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Liu
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Lee
authors.forename: Charng-Jer
authors.initials: CJ
authors.lastname: Huang
authors.forename: Ching-Ron
authors.initials: CR
authors.lastname: Cheng
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Ming-Hsiung
authors.initials: MH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007829:Laryngostenosis / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012828:Silicones; D015607:Stents; D014135:Tracheal Stenosis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D012828:Silicones