Management of synchronous subglottic stenosis and bronchial stenosis with a modified endotracheal tube.

We present the case of a tracheostomy tube-dependent 6-month-old infant with synchronous airway lesions, including grade III subglottic stenosis and left main bronchomalacia with recurrence of granulation tissue and stenosis. Because the infant was at high risk for complications from the tracheostomy tube, decannulation was the desired outcome. The airway lesions were managed by single-stage laryngotracheal reconstruction and short-term stenting of the subglottis and left main bronchus. The greatest challenge was management of progressive stenosis caused by recurrence of granulation tissue in the left main bronchus. A novel modification of a soft silicone elastic endotracheal tube was devised to provide continued ventilation of both lungs while the corrected lesions healed. The role for this type of stent and the benefits and difficulties associated with its use are discussed.