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Index >  Technique  > The Montgomery® T tube
The Montgomery® T tube

The Montgomery® T tube, designed in Boston circa 1965, was the first dedicated airway stent to be used in interventional bronchoscopy. This stent has proven invaluable in the treatment of complex tracheal stenoses.

Placement of a Montgomery® T tube requires a tracheostomy.

The stent is made of silicone and shaped like a T. Two of its branches will be located in the trachea, and one in the tracheostomy stoma.

This stent is widely used today and can be employed in the treatment of tight stenoses or complete obstruction.

The Montgomery® T tube should not be confused with a conventional tracheostomy cannula.

The external limb must be in place. If a Montgomery® T tube cannot be kept closed, emergent consultation is imperative. Contact with the outside air can be accompanied by rapid life-threatening obstruction resulting from accumulation of thick secretions.

Inexperienced clinicians may mistakenly uncap the T tube’s external limb in response to respiratory distress. The consequences can be dramatic.

Placement of the Montgomery® T tube

The Montgomery T tube is often placed one week after tracheostomy in order to avoid infection at the stoma site, and be sure that healing of the stoma is progressing normally.

Endoscopic control with a rigid bronchoscope is best in order to make precise adjustments.

Initially, the endoscopist places the upper limb of the stent in the trachea, and uses the alligator forceps to make careful adjustments during deployment, while an assistant inserts the inferior branch through the tracheostomy orifice.



Choice of Montgomery® T tube

The choice of Montgomery® T tube is essential, including maximum stent diameter and the length of both tracheal limbs. The upper limb should rest approximately 1 cm away from the vocal cords. This measurement is complicated because it is readily altered by re-positioning the head of the patient. That is, a Montgomery® T tube might seem adequately deployed when the patient’s neck is hyperextended, yet damage the vocal cords when the patient’s neck is flexed. This can result in debilitating granulomatous inflammation. If the stent is not perfectly adapted to the airway, it is best to replace it immediately instead of having to deal with an emergency later on.

Surveillance

The immediate post-operative period is very important. Verification of normal respiration in the recovery room with the stent capped is essential. The patient’s breathing, phonation, and swallowing should be entirely normal. Otherwise, modification or replacement of the stent might be necessary. The patient and his or her family should be instructed in the stent’s care, and the referring physician informed. The instructions must be precise : the stent should remain capped at all times, unless it is being cleaned. The Montgomery® T tube should be cleaned twice daily with saline, morning and evening, followed by aspiration of secretions. Surveillance fiberoptic bronchoscopy should be carried out one week after stent placement.

 
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