Description

The Montgomery Salivary Bypass Tube (MSBT) is a specialized medical device crafted by Boston Medical Products, Inc., designed to address complex clinical needs in the cervical esophagus and hypopharynx. This innovative stent is primarily used to manage and prevent fistulae, such as pharyngocutaneous and tracheoesophageal fistulae, as well as strictures that may arise following head and neck surgeries, including total laryngectomy.

Clinical Applications

The MSBT is particularly beneficial for patients who have undergone surgery, radiation, or experienced trauma or caustic ingestion, where traditional conservative treatments have not succeeded. It effectively directs saliva into the distal esophagus, promoting the spontaneous closure of fistulae and enhancing tissue conditions for potential further repair. This functionality not only aids in wound healing but also facilitates oral feeding by reducing salivary leakage.

Design and Features

• Funnel-Shaped Proximal End: The tube's design includes a funnel-shaped proximal end that fits securely in the hypopharynx, minimizing reflux and ensuring effective redirection of oral contents.
• Compatibility with Feeding Tubes: It can accommodate a feeding tube, providing additional nutritional support when necessary.
• Material Options: Available in clear and radiopaque versions, the tube is made from implant-grade silicone, with the radiopaque version incorporating barium sulphate and titanium dioxide for enhanced visibility.
• Size Variability: Offered in sizes ranging from 8 to 20, with specific dimensions tailored to meet diverse patient needs.

Patient Comfort and Safety

The MSBT is designed with patient comfort in mind, being both flexible and soft. It is MRI safe and supplied sterile, with each tube individually packaged. Placement is typically performed under general anesthesia or superficial sedation using direct laryngoscopy, and may involve an introducer for accurate positioning.

Long-Term Management

Suitable for both short-term and long-term use, the device has an expected lifetime of up to six months, though documented cases show usage extending up to three years. Regular monitoring by a physician is essential to ensure proper placement and to manage any potential complications.

Precautions

Patients should avoid exposure to laser therapy, argon plasma coagulation, and other heat-based procedures while using the MSBT, as these could lead to tissue injury or damage to the device. Potential complications, though rare, include foreign body sensation, dislocation, and localized pressure necrosis.

Conclusion

The Montgomery Salivary Bypass Tube represents a critical tool in the management of complex esophageal and hypopharyngeal conditions, enhancing patient outcomes through improved wound healing and quality of life post-surgery. Its thoughtful design and robust material composition make it a reliable choice for healthcare providers addressing these challenging medical scenarios. Regular follow-up and monitoring are recommended to maximize the therapeutic benefits of this advanced medical stent.