Intracapsular Tonsillectomy for Keratosis Pharyngeous: A Pilot Study of Postoperative Recovery and Surgical Efficacy

Abstract

Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.

Intracapsular versus extracapsular dissection tonsillectomy for adults: A systematic review

“…19 Gaudreau et al noted no cases of dehydration postoperatively in either group. 27 There were no recorded Clavien Dindo grade IV to V serious complications.…”

“…19 Appropriate blinding of outcome assessors occurred in six studies. 14,[22][23][24]26,27 Incomplete outcome data. Two trials reported no post-randomization drop-outs and all patients that received treatment were followed-up.…”

“…24 Dropouts and loss to follow-ups were not analyzed with an intention-to-treat principal in six studies. 14,19,23,25,27,28 Selective reporting. None of the studies included in the review had attached published protocols with predefined outcomes.…”

“…19,[23][24][25][26] Four studies did not state any source of funding or conflicts of interest. 14,22,27,28 Only two studies stated similar operator experience using both techniques. 19,26 Hall et al mentioned varying experience with traditional ECDT and less than five-case experience with ICDT.…”

“…Early postoperative pain was recorded in 6 studies. 19,22,23,25,27,28 A variety of scales (eg, VAS) were used to measure pain scores. Four studies (n = 160, ICDT: 87, ECDT: 73) reported continuous data with a SMD of -0.74 (95% CI, −1.27 to −0.21).…”