title: Outcome and safety of the Montgomery T-tube for laryngotracheal stenosis: a single-center retrospective analysis of 546 cases.
abstract: OBJECTIVE
  We retrospectively analyzed the surgical outcome and safety of the Montgomery T-tube for laryngotracheal stenosis.
  
  
  METHODS
  The patients with laryngotracheal stenosis who had undergone T-tube placement between 1996 and 2010 were reviewed. The severity of the stenosis was evaluated using the Cotton-Myer staging method. The primary endpoint was the rate of successful extubation and the secondary endpoint was safety.
  
  
  RESULTS
  546 patients were eligible. T-tubes were successfully extubated in 342 patients 6-24 months following intubation. The initial extubation success rate was 62.3%. Laryngotracheal restenosis following extubation occurred in 192 patients, necessitating T-tube placement for a second time. The success rate for the second attempt was 58.9%. The overall success rate was 83.3%. Hemoptysis was reported in 8 patients, postoperative infection in 6 patients, wound dehiscence in 3 patients, laryngeal obstruction in 13 patients, aspiration in 12 patients, and postoperative tracheoesophageal fistula in 2 patients.
  
  
  CONCLUSIONS
  This large clinical series demonstrated the safety and effectiveness of the T-tube for grade 1 and 2 stenosis with stenosed segments of <6 cm. For those being >6 cm, tracheal end-to-end anastomosis is not appropriate and long-term placement of a T-tube is recommended. Our findings provide useful guidance for preoperatively selecting patients with laryngotracheal stenosis of various causes and differing severity.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Song
authors.initials: S
authors.lastname: Shi
authors.forename: Donghui
authors.initials: D
authors.lastname: Chen
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Li
authors.forename: Wu
authors.initials: W
authors.lastname: Wen
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Shen
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Shicai
authors.initials: S
authors.lastname: Chen
authors.forename: Hongliang
authors.initials: H
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D020878:Device Removal; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007829:Laryngostenosis / Q000145:classification / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome