Airway recanalization followed by montgomery T-tube placement for severe subglottic stenosis in an adolescent: a case report

Background Post-intubation subglottic stenosis (SGS) in adolescents is a progressive acquired airway disorder that can substantially impair quality of life. Both surgical and interventional airway therapies are effective treatment options for SGS; however, each carries considerable technical demands, procedural risks, and potential complications. Interventional airway therapy relieves airway obstruction, maintains airway patency, restores airway and phonatory function, and has a less invasive profile, positioning it as a key treatment modality for SGS. Case presentation A 15-year-old girl sustained a traumatic brain injury following a motor vehicle accident. She received endotracheal intubation and mechanical ventilation in the intensive care unit for two weeks, followed by tracheostomy. After cognitive and motor function recovered, attempted complete occlusion of the tracheostomy tube provoked dyspnea. Subsequent bronchoscopic examination revealed subglottic stenosis. Diagnosis Bronchoscopic examination demonstrated approximately 98% subglottic airway stenosis involving a segment of roughly 2 cm with a funnel-shaped morphology, consistent with acquired post-intubation SGS. Interventions A multidisciplinary team developed an individualized treatment strategy that included rigid bronchoscopy-assisted respiratory support, airway recanalization, Montgomery T-tube placement, perioperative pulmonary hygiene management, and surveillance for procedure-related adverse events. Results Airway recanalization, including electrocautery incision, laser ablation, and balloon dilation, was performed successfully with rigid bronchoscopic support, restoring the tracheal lumen to approximately 1 cm in diameter. After the airway mucosa had stabilized, a Montgomery T-tube was implanted. Following T-tube placement, the patient regained phonatory function and experienced marked improvement in dyspnea. Computed tomography confirmed appropriate positioning of the Montgomery T-tube. Follow-up bronchoscopy demonstrated a patent lumen without significant secretion retention or granulation tissue formation.