Montgomery T-tube tracheal stent implantation with high-flow nasal oxygen under conscious sedation: A case report

Montgomery T-tube tracheal stent placement is a well-established treatment for severe subglottic stenosis. This procedure is typically performed using a rigid bronchoscope under general anesthesia. However, a major limitation of this approach is the requirement for neck hyperextension, which is not feasible in patients with cervical spine injuries. This report details a complex case of subglottic stenosis in a patient with a cervical spinal cord injury and incomplete paraplegia, in whom conventional Montgomery T-tube tracheal stent placement was difficult to achieve. We performed Montgomery T-tube tracheal stent implantation under conscious sedation with oxygen support provided by high-flow nasal cannula, minimizing the risks of general anesthesia and cervical manipulation. The successful outcome suggests that the combination of conscious sedation and high-flow nasal cannula may represent a safe and practical strategy for treating carefully selected complex airway cases. Although this case highlights a promising pathway, further studies are required to confirm the efficacy of this strategy and define its clinical indications in larger patient populations.