Conclusions

A silicone T tube developed by Montgomery is an important adjunct in surgery of the airways.2,3 In a patient with a functional larynx, it offers the closest approximation to a normal airway with good humidification of the lower airways, preservation of voice, and social acceptability. Daily care is easy and not rigidly demanding. I generally prefer the immediate access provided by these tubes over fixed or inlying stents that are inaccessible from the outside. A T tube does not preclude later surgical treatment. In 10 of 12 patients with subglottic stenosis, a tube placed through the vocal cords was tolerated quite well, as pointed out by Cooper and colleagues.4 At present, for the patient with a benign but unreconstructible lesion of the trachea, the T tube appears to be an excellent method of providing a stable and dependable airway.

Inlying silicone stents of the Dumon type, with projecting knobs to hold the stent's position, tend to migrate, especially when used in the upper trachea. Expandable metallic stents, coated or not, may incite serious, sometimes irreversible, obstructing granulations, limiting their advisability for treatment of benign lesions (see Chapter 40, "Tracheal and Bronchial Stenting").12 The silicone T tube obviates all these problems but presents the disadvantage of an opening to the surface of the neck.

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