Recurrent Pediatric Upper Tracheal Stenosis Stabilized with a Montgomery Airway Stent: A Case Report.

BACKGROUND

Pediatric post-intubation upper tracheal stenosis is uncommon but clinically important. High cervical lesions near the vocal cords are especially challenging because of recurrence risk and poor tolerance of airway stents.

CASE PRESENTATION: A 10-year-old boy developed progressive dyspnea and inspiratory stridor over four months after a motor vehicle accident requiring endotracheal intubation for seven days. On presentation, respiratory rate was 26 breaths/min, oxygen saturation was 92-93% on room air, and stridor was present at rest. Rigid bronchoscopy demonstrated a 2-cm Myer-Cotton grade II upper tracheal stenosis approximately 2 cm below the vocal cords. Endoscopic dilation provided only transient improvement, with recurrence within three weeks. He underwent cervical tracheal resection with end-to-end anastomosis. Early postoperative restenosis developed, with bronchoscopic granulation-like tissue and exposed anastomotic sutures requiring repeat dilation, debridement, and suture removal. A silicone stent placed immediately below the vocal cords was poorly tolerated, causing severe stridor and laryngeal edema requiring emergency tracheostomy and later stent removal. A Montgomery airway stent was subsequently placed. Respiratory rate improved to 16 breaths/min, oxygen saturation increased to 96%, and stridor resolved. At two-week follow-up, he was breathing comfortably without a tracheostomy cannula.

CONCLUSION

Montgomery airway stenting may provide effective short-term stabilization for recurrent high cervical pediatric tracheal stenosis complicated by anastomotic granulation, suture exposure, and silicone stent intolerance.