Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children

Blackshaw, Helen; Springford, Laurie Rigueros; Zhang, Lai-Ying; Wang, Betty; Venekamp, Roderick P; Schilder, Anne G. M.

doi:10.1002/14651858.cd011365.pub2

Cited by 30 publications

(39 citation statements)

References 88 publications

(4 reference statements)

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“…Partial tonsillectomy, also called tonsillotomy, is becoming more frequent in Sweden and has shown good treatment results 129,132 . Children seem to return faster to normal activity after tonsillotomy compared to tonsillectomy; nevertheless, the long-term effect and need for repeated surgery is still uncertain 133 . Children with non-severe OSA who receive intranasal steroids and leukotriene antagonists have shown improvement in their PSG parameters as well as their QoL [134][135][136] .…”

Section: Other Treatment Methodsmentioning

confidence: 99%

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Fehrm

Nerfeldt

Browaldh

et al. 2020

JAMA Otolaryngol Head Neck Surg

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Section: Other Treatment Methodsmentioning

confidence: 99%

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Fehrm

Nerfeldt

Browaldh

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…10 In these cases, tonsillectomy is usually associated with a higher risk of postoperative bleeding. 11 In the current study, 109 patients (58.6%) had one of the aforementioned indications. This further confirms the higher bleeding risk following surgery on inflamed tonsils.…”

Section: Discussionmentioning

confidence: 65%

Is Postextracapsular Tonsillectomy Bleeding More Common on the Side of the Surgeon’s Nondominant Hand?

Masalha

DeRowe²,

Landsberg

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To determine the difference in bleeding when extracapsular tonsillectomy with electrocautery is performed on the dominant and nondominant side of the surgeon’s hands. Study Design Retrospective cohort study. Setting Academic university hospital. Methods Medical record data of patients who were admitted with posttonsillectomy bleeding from January 1, 2000, to July 31, 2017, were reviewed. Included were age, sex, surgical indication, side of posttonsillectomy bleeding, and time of bleeding. Information on the surgeon’s dominant hand was also collected. All patients underwent total extracapsular resection with electrocautery. Results Of 280 patients, 186 met the inclusion criteria, 116 (62.3%) males and 70 (37.7%) females. Ages ranged from 2 to 74 years (mean ± SD, 17 ± 13 years; median, 13 years). In 136 cases (73.1%), bleeding was on the side of the surgeon’s nondominant hand ( P < .0001). In 50 (26.9%) cases, bleeding was on the side of the surgeon’s dominant hand. The odds ratio of bleeding on the side of the surgeon’s nondominant hand compared to the dominant hand was 8.99. Conclusion The risk of bleeding following extracapsular tonsillectomy with electrocautery on the side of the surgeon’s nondominant hand is significantly higher than on the side of the dominant hand. Thus, additional caution is required when operating on the nondominant side of the oral cavity in extracapsular tonsillectomy using electrocautery. These findings raise questions regarding dexterity as a risk factor for posttonsillectomy bleeding.

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“…Intracapsular tonsillectomy or tonsillotomy with partial resection of tonsils instead of the classical complete tonsillectomy is becoming more commonly used for the treatment of children with SDB. 55 Some studies showed that tonsillotomy resulted in a faster recovery and slightly lower risk of postoperative complications of bleeding and pain. However, more robust data from high-quality and long-term studies are needed to confirm its effectiveness and the risk of recurrence.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…However, more robust data from high-quality and long-term studies are needed to confirm its effectiveness and the risk of recurrence. 55 Children with risk factors for postoperative complications include young age less than 3 years, severe OSAS with an AHI score of >20 events per hour, cardiac complications, obesity, pre-existing structural comorbidities, or concurrent respiratory infections and should be subjected to at least a period of overnight in-patient observation postoperatively. 1 , 10 Adiposity and elevated leptin in obesity may also affect the metabolism of analgesic drugs such as morphine during postoperative care.…”

Section: Treatment Optionsmentioning

confidence: 99%

Paediatrics: how to manage obstructive sleep apnoea syndrome

Leung¹,

Cheng²,

Chan³

2021

DIC

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Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.

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Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children

Cited by 30 publications

References 88 publications

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Is Postextracapsular Tonsillectomy Bleeding More Common on the Side of the Surgeon’s Nondominant Hand?

Paediatrics: how to manage obstructive sleep apnoea syndrome

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