Use of Montgomery (R) T-tube in laryngotracheal reconstruction in children: Is it safe?

Montgomery(R) T-tubes are often used in adult patients; however, they are l ess commonly used in the pediatric age group. The purpose of this report is to describe our experience with this stent in pediatric laryngotracheal re construction. A retrospective chart review was performed to identify early and late complications. Nutritional assessments were made on the basis of w eight percentile comparisons at the time of surgery and at the end of the s tenting period. From 1990 to 1997, the Montgomery(R) T-tube was utilized in 26 children undergoing 36 airway reconstruction procedures (21 laryngotrac heoplasties and 15 cricotracheal resections). The upper limb of the tube ex tended above the level of the glottis in all patients. The patients ranged in age from 2.4 to 17.9 years. The duration of stenting ranged from 2 weeks to 23 months. Three patients (11.5%) had significant aspiration and did no t improve following diet modifications and swallowing therapy, requiring tu be feedings. One patient had postoperative subcutaneous emphysema that reso lved spontaneously. Three patients required early removal of the stent due to an inability to tolerate plugging. Granulation tissue above the upper li mb of the stent during the stenting period was noted after 6 laryngotrachea l reconstruction procedures (16%). Only 1 patient fell off his growth curve s during the period of stenting. There were no deaths in this series, and n o emergent procedures were required. Postoperative and home care and manage ment of complications are discussed. Our experience indicates that Montgome ry(R) T-tubes can be utilized relatively safely in children, providing that postoperative and home care are meticulous.