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Note: photos above were taken a the time of completion laryngectomy after a Montgomery stent had been in place for over 6 months in the management of intractable aspiration.

The second line of photos show the neck incision made to secure the Montgomery stent with the buttons depicted.

return to protocols: Laryngeal Stent Placement for Aspiration

see also: Near-field laryngectomy for aspiration case example

Modified Operative Note:

We then proceeded to evaluate the patient's larynx with a direct laryngoscopy. An approximately 2 cm incision was made above the tracheostomy, which did not communicate with the tracheostomy. We dissected down to the level of the cricoid cartilage. At this point we then proceeded to prepare for placement with an adult small Montgomery laryngeal stent. We first placed a 2-0 Prolene through the tracheostomy site. This was then identified with a 0-degree endoscope through the larynx and pulled through the larynx and out the mouth. We then placed two 2-0 Prolene sutures through a single plastic button. The two 2-0 Prolene sutures were then advanced through the right and left cricothyroid membrane. The needles were identified endolaryngeally and were pulled through extraorally. With the extraoral needles, these were then directed through the small Montgomery laryngeal stent. Two channels were placed laterally with spinal needles and an additional 2 channels were placed from superior to inferior to pull the suture through. The Prolene sutures were threaded through this and were then tied on the superior aspect of the laryngeal stent. Using all 3 sutures we then directed the laryngeal stent into the larynx. This was well seated below the false vocal cords and in the glottis. We then proceeded to remove the midline suture that had been previously placed through the trachea. We then proceeded to secure the 2 Prolene sutures that were through the plastic button and this was sutured down securely. The patient's final condition consisted of a laryngeal stent placed and well seated in the larynx and then an extratracheal button sewn with the 2-0 Prolene sutures. The Rusch tube was then replaced for a 6.0 cuffed Shiley. We then proceeded to close the incision that the button had been placed through. This was done with deep interrupted Vicryl sutures to reapproximate the soft tissue over the button. We then proceeded to close the skin with 5-0 nylon suture.

Note photos immediately below were taken a the time of completion laryngectomy after a Montgomery stent had been in place for over 6 months in the management of intractable aspiration.

The second line of photos show the neck incision made to secure the Montgomery stent with the buttons depicted