The Unreconstructible Trachea T Tubes and Stents

T tubes had been devised and variously employed in the past, as by Bond in 1891 and Falbe-Hansen in 1955, citing Laurens' earlier use of a T tube.184,185 Aboulker and colleagues treated postintubation injuries with a T tube in 1960.186 The silicone rubber T tube developed by Montgomery in 1965 proved widely useful in tracheal surgery, although it was developed initially in the false hope that prolonged stenting would resolve

figure 7 Hermes C. Grillo, MD, Chief of General Thoracic Surgery, Emeritus and Senior Surgeon, Massachusetts General Hospital (MGH), and Professor of Surgery Emeritus, Harvard Medical School. The picture shows Dr. Grillo commencing a cervicomediastinal exenteration in 1966. His first assistant is Mortimer J. Buckley, then Chief Resident in Surgery at MGH, later to become Chief of Cardiac Surgery.

figure 7 Hermes C. Grillo, MD, Chief of General Thoracic Surgery, Emeritus and Senior Surgeon, Massachusetts General Hospital (MGH), and Professor of Surgery Emeritus, Harvard Medical School. The picture shows Dr. Grillo commencing a cervicomediastinal exenteration in 1966. His first assistant is Mortimer J. Buckley, then Chief Resident in Surgery at MGH, later to become Chief of Cardiac Surgery.

tracheal stenosis.187 Cooper and colleagues in 1981 and Gaissert and colleagues in 1994 used it for permanent and temporary restorations of airway continuity when the trachea was not reconstructible, a lesion was not removable, or a temporary airway was needed.188,189 Westaby and colleagues added a bifurcated T tube for help in carinal problems.190

The development and deployment of stents will not be reviewed here. However, caution needs to be raised against tendencies to use essentially permanent expandable stents where lesions might otherwise be readily and definitively corrected by surgery. The result too often is doubly negative: correction of the lesion is permanently prevented and severe complications may develop from the stent.191 Removable silicone stents also hinder curative treatment and may quite readily cause granulations, especially in the subglottic region. These are sometimes reversible, however, in contrast to problems caused by permanent stents.

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