Case report: Anesthetic Management for an Adult Patient with Spondylothoracic Dysostosis and Tracheal Stenosis with Montgomery T-tube Insertion

Background: Spondylothoracic dysostosis (STD) is a rare congenital disorder characterized by short-trunk dwarfism, vertebral anomalies, and severe thoracic insufficiency syndrome. Its management is challenging due to complex anatomical and respiratory features, often requiring multidisciplinary surgical interventions and advanced airway management techniques. Case: We report a 19-year-old male with STD who underwent multiple thoracic and spine surgeries during childhood. He had a history of difficult intubation and subsequently required chronic tracheostomy. He developed tracheal stenosis following long-term tracheostomy use, which required laser tracheoplasty and insertion of a Montgomery T-tube (MTT) for tracheal stenting. The distorted airway posed significant airway challenges; a bronchoscopy-guided tracheostomy tube exchange was eventually performed, followed by an uneventful tracheoplasty and MTT insertion for stenting. Conclusions: STD poses significant anesthetic and surgical challenges due to airway abnormalities and respiratory insufficiency. Multidisciplinary planning and individualized airway strategies are essential for safe perioperative care in such complex cases.