Efficacy and long-term outcomes of montgomery T-tube placement in benign subglottic stenosis

Objective To evaluate the efficacy and long-term outcomes of Montgomery T-tube placement in patients with benign subglottic stenosis. Methods We retrospectively analyzed the clinical data of 45 patients with benign subglottic stenosis treated with Montgomery T-tube placement at Beijing Tian Tan Hospital and Beijing Chuiyangliu Hospital between May 2015 and May 2025. The etiologies of tracheal stenosis were as follows: Iatrogenic in 41 patients (91.11%), including 29 patients (64.44%) with post-tracheotomy tracheal stenosis (PTTS) and 12 patients (26.67%) with post-intubation tracheal stenosis (PITS); post-traumatic in 1 patient (2.22%); post-tuberculosis in 2 patients (4.45%); and associated with chronic obstructive pulmonary disease (COPD) in 1 patient (2.22%). Results All 45 patients successfully underwent T-tube placement. Among them, 39 patients achieved sustained airway patency and restored phonatory function following T-tube insertion, defined as successful retention (39/45, 86.67%). Six patients required tube removal within 2 weeks due to granulation tissue proliferation or mucus plug obstruction, defined as retention failure (6/45, 13.33%). Intraoperative complications primarily included mucosal lacerations (12 cases, 26.67%), all of which healed spontaneously within 1 week postoperatively. Short-term postoperative complications mainly comprised subglottic edema (31 cases, 68.89%), mucus plug obstruction (24 cases, 53.33%), and granulation tissue proliferation (10 cases, 22.22%). At the end of follow-up, 14 of the 39 patients (35.9%) were successfully decannulated and achieved long-term airway stability. The cumulative median tube retention time was 20.5 months. Of the 39 patients, 25 (64.10%) continued to require long-term T-tube retention. Multivariate regression analysis further indicated that a higher Cotton–Myer grade was independently associated with a significantly lower likelihood of successful decannulation ( OR = 0.168, 95%CI: 0.031–0.920, P 0.05). Conclusion Montgomery T-tube placement is a safe and effective interventional treatment for benign subglottic tracheal stenosis. It provides durable airway patency and functional improvement, particularly when surgical reconstruction is not feasible.