The concept of using a stent to maintain airway patency in the presence of airway obstruction dates back at least to the late 1800s.
Airway obstruction can be glottic (involving vocal cords) subglottic, tracheal or bronchial.
In some cases surgery is not always the best choice, in others, surgery can be performed but restenosis can be a complication.
In this study we focused on comple subglottic stenosis.
In those patients who refuse a permanent tracheostomy we propose the implant of a temporary silicone custom made prothesis used as bridge for surgery or to treat restenosis complication after surgery.
Complex subglottic stenosis is often difficult to treat with commercially available stents.
The on-site customization of air- way stents is not a new idea. It consists in the modification of stent length. Breen and Dutau reported a more complex on-site customization as the defenestration of stent to enable ventilation of lobes that would otherwise become obstructed by the sides of the silicone stent. However so far, no author reported using 2 different size stents to create a hourglass shaped stent.
Despite in the Dutau's series, the use of the on-site-modified stent did not increase the complication rates, it certainly remains a temporary treatment. In our specific series, telescoping a smaller stent into a larger one and anchoring the 2 parts to obtain a unique stent changed the inner area and reduced the elasticity and radial force of the stent with potential risk of plugging and/or dislocation. These defects were corrected in the new custom made stent that had a smoother internal surface and a unique body.