Role of subtotal tonsillectomy (‘tonsillotomy’) in children with sleep 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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The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002544 ◽

2006 ◽

Vol 120 (12) ◽

pp. 993-1000 ◽

Cited By ~ 38

Author(s):

J A Koempel ◽

C A Solares ◽

P J Koltai

Keyword(s):

Sleep Disordered Breathing ◽

The United States ◽

Adenotonsillar Hypertrophy ◽

Post Operative Pain ◽

Obstructive Sleep ◽

Tonsil Surgery ◽

Partial Tonsillectomy ◽

Obstructive Sleep Disordered Breathing ◽

Intracapsular Tonsillectomy ◽

Disordered Breathing

Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as ‘tonsillotomy’, specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a ‘partial’ procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the ‘partial’ procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a ‘partial’ procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

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Impact of Sleep-Disordered Breathing on Coagulation: the Role of COPD Should Be Clarified

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.183.12.1731 ◽

2011 ◽

Vol 183 (12) ◽

pp. 1731-1731

Author(s):

Yi-Fong Su ◽

Kun-Ta Chou

Keyword(s):

Sleep Disordered Breathing ◽

Disordered Breathing

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MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing

Healthcare ◽

10.3390/healthcare7030097 ◽

2019 ◽

Vol 7 (3) ◽

pp. 97

Author(s):

Ankit Patel ◽

Bhik Kotecha

Keyword(s):

Sleep Disordered Breathing ◽

Sleep Apnoea ◽

Long Term Outcomes ◽

Sustained Improvement ◽

Radiofrequency Surgery ◽

Obstructive Sleep ◽

Good Quality Research ◽

Disordered Breathing

Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.

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