TEMPORARY AND PERMANENT RESTORATION OF AIRWAY CONTINUITY WITH THE TRACHEAL T-TUBE

The advantages of the tracheal T-tube compared with a regular tracheos tomy tube are a physiologic direction of air flow, preservation of lar yngeal phonation, and superior patient acceptance. Between 1968 and 19 91, 140 patients aged 7 months to 95 years underwent placement of T-, TY- (n = 7), or a modified extended T-tube (n = 4). Primary diagnosis was postintubation stenosis in 86 patients, burn injury in 13 patients , malignant airway tumors in 12 patients, and various disorders in 29 patients, Stenting with a silicone rubber tube was temporary in 31 pat ients and 14 underwent later operative reconstruction. Definitive perm anent insertion was performed in 49 patients. A modified tube was used in 4 patients with left main bronchial stenosis with effective long-t erm palliation in 3. Postoperative airway obstruction prompted placeme nt in 32 patients. Positioning of the T-tube above the vocal cords in 12 patients for subglottic stenosis was effective in 10. The T-tube wa s not tolerated in 28 patients (20%) because of obstruction of the upp er limb or aspiration. Five of 10 patients under the age of 10 years h ad airway obstruction necessitating tube removal. Long-term intubation in 112 patients exceeded 1 year in 49 patients and 5 years in 12 pati ents. Only 5 patients required tube removal for obstructive problems m ore than 2 months after placement. The tracheal T-tube restores airway patency reliably with excellent long-term results and represents the preferred management of chronic airway obstruction not amenable to sur gical reconstruction.