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A 20-year audit of the outcomes of stenting with the Montgomery Safe-T-Tube at a tertiary hospital in South Africa

Published online by Cambridge University Press:  11 October 2022

G J Klopper Open the ORCID record for G J Klopper [Opens in a new window]  and
O V Adeniyi
G J Klopper*
Affiliation:
Department of Otorhinolaryngology, Frere Hospital/Walter Sisulu University, Faculty of Health Sciences, East London
O V Adeniyi
Affiliation:
Department of Family Medicine, Cecilia Makiwane Hospital/Walter Sisulu University, Faculty of Health Sciences, East London, South Africa
*
Author for correspondence: Dr Gerhard Klopper, Department of Otorhinolaryngology, Frere Hospital/Walter Sisulu University, Faculty of Health Sciences, East London, South Africa, 5247 E-mail: [email protected]
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Abstract

Objective

This study aimed to describe the epidemiology of laryngotracheal stenosis within a resource-constrained setting, whilst exploring the outcome correlates unique to Montgomery Safe-T-Tube stented laryngotracheoplasty.

Methods

A retrospective cross-sectional study of patients who underwent Montgomery Safe-T-Tube stented laryngotracheoplasty between January 2000 and December 2019 was performed.

Results

Amongst 75 patients, most lesions were iatrogenic (78.7 per cent) and high-grade in severity (84 per cent). Following 101 laryngotracheoplasties, 57 patients (76 per cent) were successfully decannulated. Young age (84.6 per cent; p = 0.009), low-grade stenosis (100 per cent; p = 0.034) and airway-framework structural integrity (79.3 per cent; p = 0.004) were significant correlates of success. Restenosis (n = 43; 57.3 per cent), occurring at a median of 9.37 weeks following decannulation, was predominantly associated with antecedent dilatation (96.3 per cent; p < 0.001).

Conclusion

Demographic and clinical profiles play a pivotal role in the outcomes and complications of Montgomery Safe-T-Tube stented laryngotracheoplasty. The success rate validates the procedure within a resource-limited setting. There exist critical periods following both surgery and decannulation when the occurrence of adverse events is most likely.

Keywords

Airway ObstructionLaryngeal StenosisLaryngopharyngeal RefluxTracheomalacia
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 6 , June 2023 , pp. 697 - 703
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr G Klopper takes responsibility for the integrity of the content of the paper

References

Lorenz, RR. Adult laryngotracheal stenosis: etiology and surgical management. Curr Opin Otolaryngol Head Neck Surg 2003;11:467–7210.1097/00020840-200312000-00011CrossRefGoogle ScholarPubMed
Nouraei, SA, Singh, A, Patel, A, Ferguson, C, Howard, DJ, Sandhu, GS. Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis. Laryngoscope 2006;166:1417–21CrossRefGoogle Scholar
Gelbard, A, Francis, DO, Sandulache, VC, Simmons, JC, Donovan, DT, Ongkasuwan, J. Causes and consequences of adult laryngotracheal stenosis. Laryngoscope 2015;125:1137–4310.1002/lary.24956CrossRefGoogle ScholarPubMed
Mandour, M, Remacle, M, Van de Heyning, P, Elwany, S, Tantawy, A, Gaafra, A. Chronic subglottic and tracheal stenosis: endoscopic management vs surgical reconstruction. Eur Arch Otorhinolaryngol 2003;260:374–8010.1007/s00405-002-0578-3CrossRefGoogle ScholarPubMed
Gallo, A, Pagliuca, G, Greco, A, Martellucci, S, Mascelli, A, Fusconi, M et al. Laryngotracheal stenosis treated with multiple surgeries: experience, results and prognostic factors in 70 patients. Acta Otorhinolaryngol Ital 2012;32:182–8Google ScholarPubMed
Statistics South Africa. Provincial Profile: Eastern Cape. Community Survey 2016, Report 03-01-08. Pretoria: Statistics South Africa, 2018Google Scholar
Cotton, RT. The problem of paediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope 1991;101(12 Pt 2 Suppl 56):1–34Google Scholar
Montgomery, WW. T-tube tracheal stent. Arch Otolaryngol Head Neck Surg 1965;82:320–110.1001/archotol.1965.00760010322023CrossRefGoogle ScholarPubMed
University Hospitals Bristol NHS Foundation Trust. How To: Set an Audit Sample & Plan Your Data Collection. In: https://www.uhbristol.nhs.uk/files/nhs-ubht/5%20How%20To%20Sample%20Data%20Collection%20and%20Form%20v3.pdf [22 June 2020]Google Scholar
Lano, CF Jr, Duncavage, JA, Reinisch, L, Ossoff, RH, Courey, MS, Netterville, JL. Laryngotracheal reconstruction in the adult: a ten-year experience. Ann Otol Rhinol Laryngol 1998;107:92–710.1177/000348949810700202CrossRefGoogle ScholarPubMed
Dass, A, Nagarkar, NM, Singhal, SK, Verma, H. Tracheal T-tube stent for laryngotracheal stenosis: ten year experience. Iran J Otorhinolaryngol 2014;26:37–42Google ScholarPubMed
Myer, CM 3rd, O'Connor, DM, Cotton, RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–2310.1177/000348949410300410CrossRefGoogle ScholarPubMed
Monnier, PH, Dikkers, FG, Eckel, H, Sittel, C, Piazza, C, Campos, G et al. Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 2015;272:2885–96CrossRefGoogle ScholarPubMed
Herrington, HC, Weber, SM, Andersen, PE. Modern management of laryngotracheal stenosis. Laryngoscope 2006;116:1553–7CrossRefGoogle ScholarPubMed
Norman, R, Matzopoulos, R, Groenewald, P, Bradshaw, D. The high burden of injuries in South Africa. Bull World Health Organ 2007;85:695–702CrossRefGoogle ScholarPubMed
Nicol, A, Knowlton, LM, Schuurman, N, Matzopoulos, R, Zargaran, E, Cinnamon, J et al. Trauma surveillance in Cape Town, South Africa. An analysis of 9236 consecutive trauma center admissions. JAMA Surg 2014;149:549–56CrossRefGoogle ScholarPubMed
Grillo, HC. Reconstruction of the trachea: experience in 100 consecutive cases. Thorax 1973;28:667–79CrossRefGoogle ScholarPubMed
Salassa, JR, Pearson, BW, Payne, WS. Gross and microscopical blood supply of the trachea. Ann Thorac Surg 1977;24:100–710.1016/S0003-4975(10)63716-2CrossRefGoogle ScholarPubMed
Gustafson, LM, Hartley, BE, Liu, JH, Link, DT, Chadwell, J, Koebbe, C et al. Single-stage laryngotracheal reconstruction in children: a review of 200 cases. Otolaryngol Head Neck Surg 2000;123:430–410.1067/mhn.2000.109007CrossRefGoogle ScholarPubMed
Nouraei, SM, Franco, RA, Dowdall, JR, Nouraei, SAR, Mills, H, Virk, JS et al. Physiology-based minimum clinically important difference thresholds in adult laryngotracheal stenosis. Laryngoscope 2014;124:2313–2010.1002/lary.24641CrossRefGoogle ScholarPubMed
Grillo, HC, Donahue, DM, Mathisen, DJ, Wain, JC, Wright, CD. Postintubation tracheal stenosis: treatment and results. J Thorac Cardiovasc Surg 1995;109:486–93CrossRefGoogle ScholarPubMed
Hartley, BE, Rutter, MJ, Cotton, RT. Cricotracheal resection as a primary procedure for laryngotracheal stenosis in children. Int J Pediatr Otorhinolaryngol 2000;54:133–610.1016/S0165-5876(00)00360-8CrossRefGoogle ScholarPubMed
Nouraei, SA, Ghufoor, K, Patel, A, Ferguson, T, Howard, DJ, Sandhu, GS. Outcome of endoscopic treatment of adult postintubation tracheal stenosis. Laryngoscope 2007;117:1073–9CrossRefGoogle ScholarPubMed
Tawfik, KO, Houlton, JJ, Compton, W, Ying, J, Khosla, SM. Laryngotracheal reconstruction: a ten-year review of risk factors for decannulation failure. Laryngoscope 2015;125:674–910.1002/lary.24963CrossRefGoogle ScholarPubMed
Hall, WH, Ramachandran, R, Narayan, S, Jani, AB, Vijayakumar, S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 2004;4:94CrossRefGoogle ScholarPubMed
Yamamoto, K, Kojima, F, Tomiyama, K, Nakamura, T, Hayashino, Y. Meta-analysis of therapeutic procedures for acquired subglottic stenosis in adults. Ann Thorac Surg 2011;91:1747–53CrossRefGoogle ScholarPubMed
Ward, RF, April, MM. Mitomycin-C in the treatment of tracheal cicatrix after tracheal reconstruction. Int J Paediatr Otorhinolaryngol 1998;44:221–6CrossRefGoogle ScholarPubMed
Liu, HC, Lee, KS, Huang, CJ, Cheng, CR, Hsu, WH, Huang, MH. Silicone T-tube for complex laryngotracheal problems. Eur J Cardiothorac Surg 2002;21:326–3010.1016/S1010-7940(01)01098-3CrossRefGoogle ScholarPubMed