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

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.

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.

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.