If there is a linear fracture down the thyroid then the aim of treatment is to
reduce the fracture and to prevent the anterior ends of the vocal cords from
joining together to form a web. This is done by using a piece of 0-18 mm thick
tantalum sheeting, cut to the shape shown (Fig. 98), which is placed keel end
first between the cords, and fixed by pressing the flanges over the thyroid
Fig. 98. McNaught keeL
Fig. 99. Solid stent mould, made to the shape of the larynx, used to reform the shattered larynx.
cartilage which is wired. This is called a McNaught keel and is left in place for
5 weeks. The neck, but not the larynx, must be reopened to remove it.
When the thyroid cartilage is shattered the same principles are used but the
larynx must be refashioned around a solid stent mould, which is made to the
shape of the larynx (Fig. 99), wired in place and left for at least 8 weeks. This
can be removed endoscopically.
Fractures of the hyoid are much easier to treat. The fracture is exposed and
the piece of bone on either side of the fracture is removed leaving a gap in the
hyoid which causes no functional problem.