Effect of tonsillar fossa cooling with cold saline on early post-tonsillectomy pain: A randomized, double-blind controlled study

Postoperative pain following tonsillectomy is troublesome, and non-pharmacological methods can be a valuable adjunct to reduce the intensity of pain. Cooling can attenuate the damage done to tissues by hot dissection techniques.Thestudy was aimed to assess the effect of tonsillar fossa cooling on post-tonsillectomy pain. Forty patients aged 8-18 years of American Society of Anaesthesiologists physical status I and II scheduled for elective bilateral tonsillectomy with bipolar electrocautery under general anaesthesia were recruited. After obtaining consent and approval from the institutional ethical committee, they were randomly assigned to one of the two groups. At the end of tonsillectomy, the tonsillar fossa was packed for 10 minutes using gauze soaked in ice-cold 0.9% saline (5–10 ºC) in group T (test) and saline at room temperature in group C (control). The postoperative pain scores using Faces Pain Scale-Revised (FPS–R) and sore throat were evaluated at 15 minutes, 1 hour, 6 hours and 12 hours. All the data were analyzed using appropriate statistical tests. P < 0.05 was considered significant.Pain scores were significantly lower in group T as compared to group C at all time points. (p<0.05) The rescue analgesic consumption was lower in group T.(p<0.05) There was no difference in of sore throat between two groups. Cooling of the tonsillar fossa with ice-cold 0.9% saline after hot dissection tonsillectomy is a useful adjunct in reducing postoperative pain without any significant complications.

Effect of topical bupivacaine on post-tonsillectomy pain relief in children

Tonsillectomy is a common surgery performed in paediatric otorhinolaryngology and is usually accompanied by considerable postoperative pain. Earlier literature has shown the use of topical bupivacaine for post-tonsillectomy pain relief to be promising. This study was conducted to evaluate the efficacy of topical bupivacaine application on post-tonsillectomy pain relief. Fifty consenting patients scheduled for tonsillectomy that met the inclusion criteria were enrolled in the study and assigned into two groups of 25 patients each. Group B had their tonsillar fossa packed with 0.5% bupivacaine soaked gauze for 5 minutes while Group S had normal saline. Pain intensity was measured at 1, 2, 4, 12 and 24 hours postoperatively, using the Faces Pain Scale- Revised (FPS-R). Mean scores for groups B and S at 1, 2, 4, 8, 12, 24 hours were 1.96±1.17, 2.40±0.82, 2.8±1.0, 2.88±1.17, 3.08±0.99, and 3.04±1.02 and 3.36±1.38, 4.72±1.62, 3.92±1.35, 3.76±1.45, 4.00±1.41, 3.38±0.98 respectively. The difference was significant at 1 and 2 hours only (P≤0.05). Post-tonsillectomy pain was reduced in the first two hours by application of bupivacaine soaked gauze.

Oligometastatic renal cell carcinoma in the palatine tonsil: successful resection using trans-oral robotic surgery

A man in his mid 70s was referred to head and neck outpatients with bulky tissue in the left tonsillar fossa. He had previously been treated for oligometastatic renal clear cell carcinoma (diagnosed over 15 years prior to disease recurrence) by tonsillectomy and adjuvant radiotherapy (years from primary treatment), followed by trans-oral laser surgery to his oropharyngeal recurrence 3 years later. Examination under anaesthetic and biopsy confirmed further recurrence of disease in the left tonsillar fossa, with parapharyngeal extension, which has not been previously reported in the literature. After discussion in the head and neck and urology multi-disciplinary teams meeting, the patient was offered trans-oral robotic-assisted surgery (TORS) for local control and prevention of progression of a fungating oropharyngeal mass. TORS partial pharyngectomy and left buccal artery myomucosal flap reconstruction were successfully carried out, with preservation of some swallow function.

Computed Tomography Findings of Complete Branchial Cleft Fistula

Branchial cleft anomalies are embryonic remnants of the branchial arches and are described as the second most common congenital neck mass. Depending on their extent, these anomalies are classified as a cyst, sinus, or fistula with branchial cysts being the most common. Branchial cysts deriving from the second branchial arch are by far the most common, accounting for approximately 95% of all cases. Complete second branch arch fistulas with both an internal and external opening are a rare variant of this anomaly, and even less have been well-documented on computed tomography (CT) imaging in the literature. We present here a case of a 20-year-old female with CT findings consistent with a complete second branchial arch fistula extending from the tonsillar fossa to the external lateral neck.

Eagle Syndrome- An Entity Often Misdiagnosed

Introduction Throat pain is one of the most common complaints that an otolaryngologist encounters in daily practice, there can be numerous aetiologies to it. Eagle Syndrome is one such entity which is characterized by chronic throat pain due to elongation of the styloid process or mineralization of the stylohyoid ligament. The vague symptomatology of this condition often leads to delayed diagnosis and treatment. Case Reports We report 5 cases of Eagle Syndrome. All the patients presented to us with complaints of chronic throat radiating to neck which did not relieve on taking medications, for the same they have been consulting multiple specialities. The diagnosis of Eagle Syndrome was confirmed by palpation in tonsillar fossa and orthopantomogram revealed enlarged styloid process measuring more than 30mm. Upon confirmation, all the 5 patients underwent tonsillo-styloidectomy and on consequent follow ups, they were symptomatically improved. Discussion Eagle Syndrome is a diagnosis of exclusion and should raise high index of suspicion in patients with nonspecific throat and neck pain not responding to any conservative treatment. With an increasing incidence of side effects following injudicious treatment given in such cases, this condition requires attention, as it a rare entity and often misdiagnosed.

Bilateral branchial arch anomaly: a rare case report

Anomalies of branchial arches are uncommon anomalies of embryonic development and may present as cysts, sinus tracts, fistulae or cartilaginous remnants. They represent the embryological precursors of face, neck and pharynx and are the second most common congenital lesions of head and neck in children. Although pharyngeal apparatus (branchial) anomalies are frequently seen, bilateral cases are rare (only 2% to 3%). Our patient was a 3 months old child with a swelling on right side of neck and discharging sinus from left side since birth. Surgical excision of the right branchial cyst with its complete tract was done along with excision of the left branchial fistulous tract upto the tonsillar fossa. Post-operative course was uneventful and patient was discharged the next day.