Current modifications of the salivary bypass tube and tracheal T-tube.

Recent changes in the salivary bypass tube and the silicone tracheal T-tube (Montgomery Safe-T-Tube) are reported. The esophageal tube, a precursor of the salivary bypass tube, was introduced as a device to bridge the gap between the pharyngostome and esophagostome following laryngoesophagectomy and the first stage reconstruction of the cervical esophagus. It has continued to serve this function as well as others and has been modified a number of times. The salivary bypass tube, a silicone modification, is currently available in four sizes. Illustrations and descriptions for inserting, maintaining, and removing this tube are presented. The silicone tracheal T-tube has been modified to prevent accidental displacement of the extraluminal portion of the T-tube into the trachea. Although this complication has been rare in 21 years of usage, it can be fatal. Ridges and grooves have been constructed on the extraluminal portion of the T-tube so that a ring can be attached to prevent posterior displacement. Drainage grooves have also been added along the long axis to aid in the drainage of secretions and to differentiate the T-tube from the silicone tracheal cannula on which there is only one longitudinal groove.