Modification of the anterior commissure technique of partial laryngectomy.

The anterior commissure technique of partial laryngectomy is useful for treating "horseshoe" lesions of the larynx. As originally described, a McNaught keel is used after the excision to maintain an open glottic chink and to prevent webbing. After three weeks, this keel is removed as a surgical procedure. During the past four years, we have treated 12 patients using 0.020-gauge Silastic sheeting to replace the McNaught keel. The Silastic sheet is anchored above and below the glottis with externally tied 2-0 proline stutures. Two to three weeks later, a direct laryngoscopy is performed and the stent is removed. This modification avoids a second surgical procedure, decreases the hospital stay, and allows for inspection of the glottis.