PMC5547240_01
A: Complex tracheal stenosis seen distal to tracheostomy tube at time of patient presentation. B: Status post therapeutic bronchoscopy and placement of extended tracheostomy tube with relief of tracheal stenosis. C: Temporary Montgomery cannula with deploying device. D: External appearance of the Montgomery cannula exiting patient's tracheal stoma. E: Montgomery cannula seen in stoma just proximal to tracheal silicone stent. F: Status post Montgomery cannula removal with stable position of tracheal silicone stent.
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Bronchoscopic examination revealed a severe complex tracheal stenosis just distal to the tracheostomy tube (Fig. 1A) with an approximate tracheal dimeter of 5 millimeters (mm). A new #8 cuffed, extended tracheostomy tube was chosen and exchanged to allow for bypassing and "stenting" of the stenosis (Fig. 1B). Decision was made to maintain patient's tracheal stoma with the placement of a temporary Montgomery cannula (Fig. 1C) to allow for tracheal suctioning and for possible reinsertion of tracheostomy tube, given patient's complex tracheal issue. The external aperture of the Montgomery cannula was capped with the included button (Fig. 1D). A silicone stent (Novatech, hourglass shape) was chosen and successfully deployed (Fig. 1E). Follow-up bronchoscopies continued to show excellent stent position and patent trachea over the next 24 months (Fig. 1F).