Improved method of insertion of a Montgomery T-tube.

INTRODUCTION The Montgomery silicone tracheal T-tube (Safe-TTube) has gained a role in laryngeal and tracheal reconstruction and revision by providing patients a longterm, indwelling stent that allows voice production and swallowing. Montgomery designed the tracheal T-tube in 1968.l The T-tube is made of silicone and therefore relatively inert and resistant to tissue reaction.2 It can be used for long-term stenting of the larynx and trachea for up to 7 years, or, if it is periodically replaced, for up to 15 years.2 The T-tube is contraindicated in a patient with aspiration or positive pressure ventilation requirement. The T-tube can be inserted to stent a tracheal or subglottic stenosis only or occasionally extend across the cords to stent a laryngeal stenosis. The tube consists of a hollow silicone tube with an intraluminal portion and perpendicular to this an extra-luminal portion that may be obtained with external grooves to hold a washer ring (Fig. 1). Montgomery described a method of insertion of the T-tube by which the inferior intraluminal portion is folded in on itself and then directed inferiorly with a hemostat.2 The extraluminal portion and superior limb of the intraluminal portion are then manipulated externally until the superior limb is across the stenosis, effectively stenting the airway. The extraluminal portion is then pulled anteriorly and secured with a ring washer. An alternative method of inserting the T-tube is described in the package insert. It involves sliding the superior aspect of the T-tube into the tracheostomy stoma over a flexible dilator, which is removed through a direct la-