Factors influencing outcomes in endoscopic management of post intubation tracheal stenosis with montgomery t tube placement.

backgroundPost-intubation tracheal stenosis (PITS) is a common late complication of prolonged endotracheal intubation or tracheostomy, leading to progressive airway obstruction. Endoscopic management with Montgomery T-tube placement provides a less invasive alternative to tracheal resection. This study evaluates clinical factors influencing outcomes following endoscopic treatment with T-tube stenting. METHODOLOGY: A retrospective chart review was conducted on patients with PITS managed at the Department of Otorhinolaryngology, AIIMS Jodhpur, between January 2019 and December 2023. Patients undergoing endoscopic management followed by Montgomery T-tube insertion, and completing at least 6 months postdecannulation follow-up, were included. Pre-operative assessment included Fibreoptic Laryngoscopy, CT imaging, and voice evaluation (VHI-10 and VRQOL). Outcome measures included need for repeated interventions, successful decannulation, and voice improvement.

resultsOf 27 patients who underwent T-tube placement, 18 met the inclusion criteria of complete follow-up, 17 achieved successful decannulation and formed the final study cohort. Nine of these (52%) required repeated procedures. Significant predictors for repeated interventions were length of stenosis (p < 0.001) and percentage of stenosis (p = 0.01). ROC analysis showed high predictive ability for stenosis length (AUC 0.889) and percentage (AUC 0.819), with cut-off values of >17 mm and >72.5% respectively. Voice outcomes significantly improved at 6 months postdecannulation (p < 0.001).

conclusionEndoscopic management with Montgomery T-tube provides effective airway restoration and voice improvement in PITS. Stenosis length and severity are key predictors of the need for repeat interventions. Proper patient counselling, compliance, and careful consideration are essential for favourable outcomes.