Tonsillotomy by a Fractional Carbon Dioxide Laser: A New Technique in the Treatment of Chronic Tonsillitis

Abstract

Introduction: Chronic tonsillitis has a global prevalence, ranging from 5% to 12%. Its clinical manifestations, like recurrent acute tonsillitis, tonsils hypertrophy, caseum and halitosis, can lead adult patients to be submitted to palatine tonsillectomy, surgery that has morbidity and the potential risk of complications, including severe bleeding. This article proposes a new therapy for chronic tonsillitis in adult patients using a fractional carbon dioxide (CO2) laser, which is a fast, minimally invasive procedure capable of removing the need for the traditional tonsillectomy in many patients. The present research aimed to verify the efficacy of tonsillotomy by fractional ablation using the CO2 laser by comparing the number of bacterial infections, tonsils hypertrophy, halitosis and caseum; it is also aimed at analyzing the benefits, risks and complications of the technique. Methods: In this clinical prospective study, 20 patients were subjected to one session of tonsillotomy by fractional ablation and were followed up for a year. The control group was formed by the same patients in the pre-procedure period (one year) without treatment. Statistical analysis: The Wilcoxon paired test, Friedman tests, and multiple non-parametric comparisons were utilized to analyze the data (significance level of 5%). Results: No complications occurred, and the procedure was fast (30 seconds), safe and tolerated well without general anesthesia. After 1 year, there was a total remission of recurrent acute tonsillitis in 95% of the patients, and after 6 months there was a statistically significant improvement in halitosis and caseum, and tonsils size reduction (P<0.05). The level of satisfaction average was 10 after 3 months and 8 after one year. Conclusion: tonsillotomy by fractional ablation using the CO2 laser is a safe, efficient procedure for chronic tonsillitis in adults, and it can be incorporated into daily clinical practice.

Selected Immunohistochemical Assessment and Clinical Examinations in the Diagnosis of Palatine Tonsil Diseases

“…At the same time, our detailed analysis makes it possible to identify with a high degree of certainty the type of tissue abnormality of the palatine tonsil that is an indication for tonsillectomy/tonsillotomy. Our data underline the view that the palatine tonsils are functional immune units and suggest that tonsillotomy, i.e., partial resection of the palatine tonsils, should be considered in the future as an alternative to total tonsillectomy (tonsillectomy) in adults [ 45 , 46 ].…”

“…The mean thickness of the subepithelial fibrosis layer was higher in the tonsillitis group, reaching 376.3, while in the tonsillar hypertrophy group, it was 248. 46. The average level of inflammatory infiltration was higher in the tonsillitis group, reaching 82.6%, while in the tonsillar hypertrophy group, it was 69.5%.…”