[Use of the Montgomery prosthesis in the treatment and prevention of anterior commissural synechiae secondary to bilateral cordectomy].

The authors report the results obtained with the use of the Montgomery silicone prosthesis for the prevention or treatment of thick and sometimes partially stenosing synechiae of the anterior commissure following bilateral cordectomy by median thyrotomy. The umbrella-shaped prosthesis consists of two silicone sheets which are perpendicular to each other. The vertical sheet is of variable length and, once placed in position, it separates at the anterior commissure the two portions of larynx operated on, so that they may be adequately reepithelized. This procedure was used in three patients undergoing internal subperichondral cordectomy by median thyrotomy, due to a malignancy in both vocal folds which, however, was not extended to the anterior commissure. In two patients the prosthesis was fitted in during the main surgical procedure to prevent an excess of scar tissue; in the third patient, by contrast, it was used to treat a thick, partially stenosing synechia in the commissure secondary to cordectomy, which had already been unsuccessfully managed under direct microlaryngoscopy. In the three patients the prostheses were left in place for 2 and a half, 3, and 3 and a half months, respectively, with no major irritation or inflammation inside the larynx. No supportive tracheotomy had to be performed, and only in one case was the prosthesis secured externally by percutaneous stitching. On indirect laryngoscopy several months after the prosthesis was removed, two patients showed a perfectly healed larynx; in the third patient a very small amount of scar tissue in excess was still present, but it did not affect his respiratory function.