Tonsillotomy in Children with Tonsillar Hypertrophy

Abstract

Tonsillectomy is one of the most frequent surgical procedures carried out on children. Obstructive sleep apnea syndrome, caused by tonsillar hypertrophy, has been attracting increasing interest and tonsillectomy is often performed as a result of this indication. Regardless of the indication, the main aim of tonsillectomy has always been to remove the tonsils completely. The present study was undertaken in order to investigate the effect of two different surgical techniques, tonsillectomy and tonsillotomy, on clinical symptoms in children with symptoms of obstructive sleep apnea syndrome due to tonsillar hypertophy. The study was conducted as a prospective, randomized trial comparing the clinical effects of standard tonsillectomy and tonsillotomy using a CO2 laser. Forty-three children aged 2-9 years were included. Both groups of patients experienced comparable relief from symptoms of snoring and apneas at follow-up after 3 months and 2 years. There was no significant statistical difference between the two groups of patients in terms of both short- and long-term effects on clinical symptoms. Tonsillotomy caused no measurable bleeding during surgery. Postoperative pain and distress were less pronounced in the tonsillotomy group according to visual analog scale evaluations made by patients, parents and nursing staff. In conclusion tonsillotomy appears to be the less traumatic surgical method in cases of upper airway obstruction in children caused by tonsillar hypertrophy.

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

“…Rosenfeld and Green reported a changing trend concerning the indication for TE with hyperplasia prevailing tonsillitis [100]. This finding supported the idea of TT replacing TE, occasionally with a certain age limit [101], [102], [103], [104], [105], [106], [107], [108]. Evidence has been given that TT is capable to resolve tonsillitis in children and adolescents by Hultcrantz and Ericsson [84], [109], [110], [111].…”

“…Age restrictions as well as assumed advantages of certain surgical instrument as demanded in various contracts are not scientifically supported [112]. Despite the increasing acceptance of TT to resolve upper airway obstruction (with or without sleep-related breathing disorder) [29], [101], [102], [103], [104], [107], [108], [113], differences in postoperative morbidity in contrast to TE were not evident in other studies. Moreover, patients run at risk to experience tonsillar regrowth after TT [114].…”

Topical biomaterials to prevent post-tonsillectomy hemorrhage

“…Attempts to reduce the morbidity of tonsillectomy have included changes to the surgical approach and peri-operative medications to reduce the risk of bleeding. Technical modifications to the procedure, such as partial or intracapsular tonsillectomy, can reduce pain and PTH [15–17]. However, such modifications are not indicated for chronic infection and can result in tissue regrowth, requiring revision surgery [18, 19].…”