Using a customizable L stent for laryngotracheal stenosis: Patterns of success and failure

A recent innovation in the management of tracheostomy-dependent patients with laryngotracheal stenosis (LTS) has been the customizable laryngotracheal stent, made by dividing a T-tube in half ("L stent"). These L stents can be placed into the subglottis as well as the posterior glottis to prevent rapid re-stenosis following surgery, and they are easily removed in the office. We sought to review our experience with these stents and analyze patterns of success and failure.

Retrospective chart review was performed of all tracheostomy-dependent patients who underwent L stent placement from January 2019 through February 2024. Clinical and demographic data were reviewed, with decannulation as the primary endpoint. Patients were assessed as having comorbid conditions (diabetes, coronary artery disease, morbid obesity, prior radiation) or not.

A total of 16 patients underwent stent placement. Six patients had posterior glottic stenosis (PGS), six had subglottic stenosis (SGS), and four had multilevel stenosis. Of these 16 patients, 9 were ultimately decannulated (56.2%). Three of the successes were PGS (33.3%), four were SGS (44.4%), and two had both SGS and PGS (22.2%). Patients who were decannulated were statistically less likely to have comorbid conditions than patients who failed decannulation (p = 0.0350).

For tracheostomy-dependent patients who have failed first-line therapy, endoscopic surgery paired with L stent placement offers a reasonable alternative to open airway reconstruction or more destructive arytenoidectomy or cordotomy procedures. As with most airway surgeries, patient selection is important, as the presence of multilevel stenosis and/or comorbid conditions can predict a higher failure rate.