Intracapsular Tonsillectomy

AbstractObjectiveThis study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.MethodsA prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.ResultsIn total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.ConclusionIntracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

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Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon’s Experience

ORL ◽

10.1159/000509479 ◽

2020 ◽

Vol 82 (6) ◽

pp. 335-342

Author(s):

Heejin Kim ◽

Sung Won Li ◽

Sung Min Park ◽

Sung Kyun Kim ◽

Seok Jin Hong ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Postoperative Pain ◽

Pediatric Patients ◽

Recurrent Tonsillitis ◽

Obstructive Sleep ◽

History Of ◽

The Mean ◽

Intracapsular Tonsillectomy

Introduction: Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. Objective: The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. Methods: A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2–14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. Results: In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. Conclusions: Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

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Powered intracapsular tonsillectomy: for pediatric tonsillar hypertrophy

International Congress Series ◽

10.1016/s0531-5131(03)01608-x ◽

2003 ◽

Vol 1257 ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

Peter J Koltai

Keyword(s):

Tonsillar Hypertrophy ◽

Intracapsular Tonsillectomy

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Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep disordered breathing

The Journal of Laryngology & Otology ◽

10.1017/s0022215113003058 ◽

2013 ◽

Vol 128 (S1) ◽

pp. S3-S7 ◽

Cited By ~ 20

Author(s):

J M Wood ◽

M Cho ◽

A S Carney

Keyword(s):

Sleep Disordered Breathing ◽

Neurocognitive Function ◽

Medline Database ◽

Post Operative Pain ◽

Operative Complications ◽

Comparable Effect ◽

Key Terms ◽

Intracapsular Tonsillectomy ◽

Disordered Breathing

AbstractIntroduction:Sleep disordered breathing in children causes disturbance in behaviour and also in cardiorespiratory and neurocognitive function. Subtotal tonsillectomy (‘tonsillotomy’) has been performed to treat sleep disordered breathing, with outcomes comparable to established therapies such as total tonsillectomy or adenoidectomy. This review critically assesses the role of subtotal tonsillectomy in a paediatric setting.Method:The Medline database (1966 to October 2012) was electronically searched using key terms including subtotal or intracapsular tonsillectomy, tonsillotomy, tonsillectomy, paediatrics, and sleep disordered breathing.Results:Eighteen papers were identified and reviewed. Subtotal tonsillectomy would appear to have an efficacy equal to that of total tonsillectomy for the treatment of sleep disordered breathing, and has significant benefits in reducing post-operative pain and analgesia use. Subtotal tonsillectomy patients appear to have less frequent post-operative haemorrhage compared with total tonsillectomy patients.Conclusion:In children, subtotal tonsillectomy is associated with fewer post-operative complications whilst having a comparable effect in improving sleep disordered breathing, compared with total tonsillectomy.

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