Extracapsular versus intracapsular tonsillectomy: Outcomes in children with a focus on developmental delay

Mukerji, Shraddha S.; Rath, Smruti; Zhang, Wynne Q.; Zhu, Huirong; Anand, Grace Shebha; Jones, John; Chelius, Daniel C.; Musso, Mary Frances; Bedwell, Joshua R.

doi:10.1016/j.ijporl.2021.110978

Cited by 7 publications

(35 citation statements)

References 14 publications

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“…The included studies consisted of 3 RCTs using a with‐in patient design, 29 , 30 , 38 5 RCTs using a between‐patient design, 32 , 33 , 34 , 41 , 45 1 prospective cohort study, 40 and 8 retrospective cohort studies. 31 , 35 , 36 , 37 , 39 , 42 , 43 , 44 Across the 17 studies, a total of 1996 patients underwent CIT. The comparator arms included total tonsillectomy using plasma ablation (9 studies, 29 , 30 , 31 , 34 , 35 , 36 , 40 , 41 , 43 n = 1100), electrocautery (4 studies, 32 , 33 , 38 , 45 n = 155), cold steel (2 studies, 37 , 44 n = 77), electrocautery or plasma ablation (1 study, 42 n = 1800), any nonplasma ablation device (1 study, 35 n = 1216) and nondefined device (1 study, 39 n = 217).…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies included pediatric patients, 30 , 31 , 32 , 33 , 34 , 36 , 39 , 40 , 41 , 42 , 44 3 included both adults and pediatric populations, 37 , 43 , 45 2 studies included adult patients, 29 , 38 and 1 did not report on age. 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies.…”

Section: Resultsmentioning

confidence: 99%

“… 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies. 36 , 38 , 40 , 41 , 42 , 43 , 44 One study determined surgical procedure based on indication, with patients receiving CIT for obstructive indications without a history of recurrent tonsillitis and total tonsillectomy with a history of recurrent tonsillitis. 31 One study did not identify indication for surgery.…”

Section: Resultsmentioning

confidence: 99%

“…This was also observed by Mukerji et al (0.86% vs 14%; p < .001). 42 Chang et al 33 identified that at 5 to 6 days postoperatively patients who underwent CIT were on statistically significantly lower doses of paracetamol than following total tonsillectomy using electrocautery ( p < .0005); however, Chang et al 34 reported no statistically significant difference in analgesia use between CIT and total tonsillectomy using plasma ablation. Tremlett et al 44 also observed no statistical differences in the doses of morphine following CIT and total tonsillectomy using cold steel.…”

Section: Resultsmentioning

confidence: 99%

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Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

2023

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Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English‐language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta‐analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5‐5.9; p < .0001), 4.1 (95% CI 2.7‐5.4; p < .0001), 3.5 (95% CI 1.7‐5.4; p = .0002) and 2.8 (95% CI 1.6‐4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16‐0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19‐1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

2023

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“…A study of 320 children with developmental delay due to a range of diagnoses compared ICT and TT. ICT had similar outcomes for symptom resolution but had reduced length of stay, less revision surgery and less need for pain relief [49].…”

Section: Adenotonsillectomymentioning

confidence: 88%

Recent advances in paediatric sleep disordered breathing

Garde

Gibson

Samuels

et al. 2022

Breathe

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This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions.Educational aimsTo understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.

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Intracapsular Versus Total Tonsillectomy in Patients with Trisomy 21

Timashpolsky,

Aggarwal,

Ruiz

et al. 2023

The Laryngoscope

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ObjectivesIntracapsular tonsillectomy and adenoidectomy (iTA) has become a popular alternative to extracapsular tonsillectomy and adenoidectomy (TT) for the treatment of pediatric obstructive sleep apnea (OSA) due to improved recovery and fewer complications. The objective of this study was to compare surgical recovery and impact on OSA of iTA versus TT in patients with Trisomy 21 (T21).MethodsThis is a case series with chart review of all T21 patients who underwent iTA or TT at our institution between July 1, 2015 and August 15, 2022. Data collected included demographics, comorbidities, preoperative sleep studies, intraoperative data, complications and recovery, postoperative sleep studies, and follow‐up data.ResultsThere were 62 (21.7%) patients who underwent iTA and 224 (78.3%) patients who underwent TT. The iTA group had significantly lower pain scores (p < 0.001), decreased use of narcotics (p < 0.001), shorter length of stay (p = 0.003), and faster return to oral intake (p = 0.01) during their postoperative hospital admission, and fewer 30‐day complications (p = 0.009) compared to the TA group. Both groups showed significant improvements in their sleep studies. For 41 (66.1%) of iTA patients who had follow‐up, median follow‐up was 1.8 years and for 169 (75.4%) TT patients, median follow‐up was 2.6 years. At follow‐up, 21 of 41 (51.2%) iTA patients and 83 of 169 (49.1%) TT patients exhibited OSA symptoms (p = 0.084) and tonsillar regrowth was not significantly different between the two groups (p = 0.12).ConclusionPatients with T21 experience less pain and fewer postoperative respiratory complications from iTA than from TT. The short‐term impact of iTA versus TT on OSA, as measured by poysomnography, does not differ between the two techniques.Level of EvidenceIII Laryngoscope, 2023

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Extracapsular versus intracapsular tonsillectomy: Outcomes in children with a focus on developmental delay

Cited by 7 publications

References 14 publications

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

Recent advances in paediatric sleep disordered breathing

Intracapsular Versus Total Tonsillectomy in Patients with Trisomy 21

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