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PubMedDate not supplied

Pediatric tonsillectomy with bipolar electrosurgical scissors.

PURPOSE: The optimal technique for pediatric tonsillectomy remains a hotly debated topic. The speed and superior hemostatic properties of electrosurgical dissection must be weighed against the greater tissue preservation and more rapid healing of cold dissection techniques. MATERIALS AND METHODS: We have used a new surgical device, bipolar electrosurgical scissors, in 30 consecutive pediatric tonsillectomies. This instrument provides mechanical cutting with or without simultaneous bipolar electrocoagulation. RESULTS: The average surgical time was 6 minutes. There was no intraoperative blood loss. There were no immediate or late post-tonsillectomy hemorrhages. All tonsillar fossae were completely healed at 2-week follow-up. CONCLUSION: Bipolar electrosurgical scissors provide the best properties of both cold dissection and electrosurgical tonsillectomy without increasing surgical time or cost.

Child↗

PubMed1997

Cervical lymph node metastasis from an unknown primary: is a tonsillectomy necessary?

PURPOSE: The detection of an infraclinical primary by tonsillectomy in case of cervical lymph node of an epidermoid carcinoma with unknown primary after a radical neck dissection, allows avoiding irradiation of the normal larynx. The aim of this study is to quantify the rate of tonsil primary to justify this procedure. METHODS AND MATERIALS: From 1969 to 1992, 87 patients had a tonsillectomy as part of the workup for cervical nodal metastasis of an epidermoid carcinoma with unknown primary. The mean age was 57 years (range: 39-75 years) and the sex ratio was 8.6. Sixty-seven patients had a single cervical adenopathy (17 N1, 30 N2a, 5 N3, 15 Nx), and 20 patients multiple cervical adenopathies (17 N2b, 3 N2c). The treatments included always an irradiation to the node areas (50 Gy), and to the pharyngolarynx in case of normal tonsil (50 Gy), or to the tonsil if it was the primary (50 Gy with a brachytherapy boost of 20-25 Gy). In this last case, the larynx could be protected. RESULTS: Tonsillectomy never induced specific complication. Out of 87 patients, 26% had a tonsil primary. There was not specific histological differentiation in this group. In the 67 patients with a single cervical adenopathy, 31% had a tonsil primary (6 N1, 7 N2, 1 N3, 7 Nx). It was a subdigastric adenopathy in 38%, a submandibular in 28% and a midjugulocarotidian in 23%. Among the 17 patients N2b, none had a tonsil primary. In the three patients N2c, two presented a tonsil carcinoma (two subdigastric nodes). CONCLUSION: Tonsillectomy allows avoiding irradiation of normal larynx in 26% of patients who have a cervical lymph node with unknown primary. It should be performed in case of a single node of the subdigastric, midjugulocarotidian or submandibular area or bilateral subdigastric adenopathies.

Adult↗

PubMed1980

Tonsillectomy and autoantibodies in patients with habitual tonsillitis.

Tonsillectomy is virtually a routine operation now for ENT surgeons, but its immunological evaluation is still obscure. We have carried out an investigation in 57 patients who visited our clinic, with reference to autoantibodies by the immunofluorescence technique. We found autoantibodies at a higher frequency after tonsillectomy than before tonsillectomy in the young age group. There are studies that report close correlation of autoantibodies and malignancy. Since there are few reports that mention the relationship of the presence of autoantibodies and tonsillectomy, we have emphasized here careful follow-up of the patients from this standpoint.

Adolescent↗

PubMed1999

Effect of chewing gum on recovery after tonsillectomy.

OBJECTIVE: Patients are traditionally advised to eat early and frequently in the initial post-tonsillectomy period to reduce the severity of pain and to facilitate early resumption to a normal diet. We investigated the action of mastication and therefore the promotion of saliva formation and deglutition on the post-operative recovery of tonsillectomy patients. METHODS: We present a prospective randomised controlled trial set up to observe the effects of chewing gum on these patients. One hundred and two patients undergoing routine tonsillectomy for recurrent tonsillitis were randomised into cases (those given chewing-gum) and control groups (those not given chewing-gum). Eighty-four patients were reviewed on the seventh post-operative day. We measured the time taken in days for the subjects to resume to their normal diet after surgery and measured pain on a daily basis. RESULTS: Our study demonstrated that chewing gum in the early post-operative period significantly delayed resumption of normal diet (Chi-squared test with Yates' correction, chi2= 4.6, P = 0.032). Chewing gum also increased the average amount of pain experienced by the cases over the controls and this became statistically significant on day 7 (mean difference = 14.8, t-test with two tailed probability, P = 0.041). CONCLUSION: We conclude that chewing gum should not be routinely advised in the early period following tonsillectomy.

Adolescent↗

PubMed2000

[What is the role of tonsillectomy in children?].

Tonsillectomy is mandatory in the case of chronic airway obstruction associated with tonsillar hypertrophy and in the case of a unilateral enlarged tonsil which may be malignant. Tonsillectomy may be indicated in recurrent tonsillitis. More rarely, tonsillectomy is performed in children for tonsil bleeding or chronic tonsillitis. Allergy and bleeding disorders are not a contraindication for tonsillectomy.

Airway Obstruction↗

PubMed1994

Velopharyngoplasty with or without tonsillectomy and/or adenotomy--a retrospective evaluation of speech characteristics in 143 patients.

Velopharyngoplasty is a well-established means of speech rehabilitation in patients with primary or secondary velopharyngeal incompetence. Principally, the result of velopharyngoplasty may be influenced by tonsillectomy or adenotomy or tonsillectomy and adenotomy because of the anatomical and physiological relations. The data of speech characteristics from 143 patients were evaluated retrospectively to determine the influence of tonsillectomy, adenotomy and both operations--performed simultaneously or at different times--on the result of velopharyngoplasty. Special regard was also given to the age at operation. The best speech rehabilitation by velopharyngoplasty was found in patients operated on before school-age, a noticeable negative influence of tonsillectomy, adenotomy or both could not be demonstrated. Therefore these operations should be considered and performed before school-age in order to achieve the best social and psychological rehabilitation.

Adenoidectomy↗

PubMedDate not supplied

Evaluation of the utility of histopathologic exam as a routine in tonsillectomies.

UNLABELLED: Tonsillectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. OBJECTIVE: Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. METHODOLOGY: retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. RESULTS: 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. DISCUSSION: The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. CONCLUSION: Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams.

Biopsy↗

PubMed1976

Improvement of recalcitrant psoriasis vulgaris after tonsillectomy.

To study the effect of tonsillectomy as a possible part of the treatment of infection-released, relapsing and recalcitrant (to topical therapy and courses of penicillin) psoriasis vulgaris in children and adolescents and to test a possible correlation between tonsillitis and exacerbations of psoriasis vulgaris, a retrospective study (charts and questionnaires) of the course of psoriasis after tonsillectomy was undertaken in 74 patients with such psoriasis. Each patient served as his own control. At tonsillectomy the average age of patients and the duration of psoriasis were 14-2 years and 4-5 years, respectively, while the average follow-up period was 4-5 years. The clearing of psoriasis vulgaris was stastically significant, p less than 0-01, as 1/3 of the patients obtained clearing of psoriasis throughout the entire follow-up period, while an additional 1/3 noticed considerable improvement of their psoriasis. After having tried both topical therapy of various sorts and courses of penicillin, tonsillectomy might be taken into consideration in relapsing, recalcitrant psoriasis vulgaris in children and adolescents.

Adolescent↗

PubMed1978

Guillotine tonsillectomy: anachronism or pragmatism.

The results of a retrospective survey comparing the complications of guillotine tonsillectomy with those of dissection tonsillectomy are given. The problem of tonsil tags and adenoidectomy are discussed and a reappraisal of the indications for guillotine tonsillectomy are considered. We feel that guillotine tonsillectomy should only be carried out in very special circumstances.

Child↗

PubMed1983

Unilateral tonsillectomy--indications and results.

Seventy-six cases of unilateral tonsillectomy performed over the last 20 years are reported. The average age was 3.75 years. Fifty per cent had adenoidectomy. A review of their case notes and of 54 questionnaires returned by parents, asking their opinion of the change in symptoms before operation and two years after operation, showed that they could be allotted into three groups: Group 1 35 cases (65 per cent) had dramatic improvement in the symptoms of allergy, colds, otitis, sore throats, eating, meat eating and sleep. Group 2 of nine cases (17 per cent) had considerable improvement in most symptoms. Group 3 of 10 cases (18 per cent) had minimal improvement. Post-tonsillectomy hypertrophy of the remaining tonsil occurred within two to four years in nine cases, necessitating removal. Four (11 per cent) in Group 1, (22 per cent) in Group 2, and three (30 per cent) in Group 3. The three secondary tonsillectomies in Group 3 gave good results in two cases. In five cases the other tonsil was removed six to 15 years later. This series of cases has demonstrated that a tremendous decrease in incidence of throat and upper respiratory tract infection in young children, apparently prone to infection can occur in over 80 per cent of cases following unilateral tonsillectomy, in spite of the continued presence of the remaining large tonsil.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗

PubMed1987

Chronic tonsillitis, tonsillectomy and sickle cell crises.

A study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p less than 0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.

Adolescent↗

PubMed1988

Antibody response to pneumococcal vaccination as related to tonsillectomy.

In each of twelve matched pairs of patients undergoing tonsillectomy one patient was vaccinated with Pneumovax, a pneumococcal polysaccharide antigen, prior to tonsillectomy, the other patient being vaccinated after tonsillectomy. Sera were tested for antibody response to three different pneumococcal types of IgG, IgA and IgM classes. The patients with intact tonsils at vaccination did not develop higher antibody response than did those tonsillectomised prior to vaccination. On the contrary, in the case of pneumococcus type 6A, the IgM antibody response in tonsillectomised patients was significantly higher than that in patients with intact tonsils at vaccination (p = 0.021). Thus, the present study did not support the notion that tonsillectomy affects antibody response against pneumococcal vaccination. The palatine tonsils' role as an immunologically reactive organ is also discussed.

Adolescent↗

PubMed1995

The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in tonsillectomy.

The aims of this study were to demonstrate the effect of bismuth subgallate and adrenaline paste application to the tonsillar fossae on operating time and peroperative blood loss during tonsillectomy. Ninety-eight patients were included in a prospective randomized trial. Bismuth subgallate powder is mixed with 10 ml of normal saline and 0.03 ml of 1:1000 adrenaline to make a paste. This paste is used as a topical haemostatic agent during tonsillectomy. Bismuth subgallate activates Factor XII and therefore accelerates the coagulation cascade. Adrenaline causes vasoconstriction and promotes platelet aggregation. The application of bismuth subgallate and adrenaline paste to the tonsillar fossae during tonsillectomy reduces operating time by 23 per cent for Consultant staff (p < 0.05) and 32 per cent for Junior staff (p < 0.05). Blood loss is reduced by 21 per cent (p > 0.05), for the average paediatric tonsillectomy.

Adolescent↗

PubMed1995

KTP-532 laser tonsillectomy--a potential day-case procedure?

We report the results of a prospective pilot study of 54 adult patients undergoing tonsillectomy using the KTP-532 laser, designed to assess whether the technique would facilitate day-case adult tonsillectomy. Subjective and objective assessment at six hours post-operatively showed that only 43 per cent could, in our judgement, have been discharged at this interval. Furthermore, the overall complication rate was 31 per cent with a secondary haemorrhage rate of 19 per cent. We conclude that KTP-532 laser tonsillectomy as performed in this pilot study compares unfavourably with dissection tonsillectomy and we discuss possible reasons for this.

Adolescent↗

PubMed1995

Would day-case adult tonsillectomy be safe?

Day-case surgery is increasing to improve health care efficiency. Adult tonsillectomy is performed on an inpatient basis in the UK because of safety concerns regarding primary haemorrhage. This study aims to investigate the likely safety of day-case tonsillectomy in adults, by defining the incidence and timing of primary haemorrhage and therefore to establish a safe time period for same-day discharge. Prospectively recorded data on 2,157 adult tonsillectomies over a five-year period were reviewed. Serious primary haemorrhage was uncommon (0.8 per cent). The 95 per cent reference range of time to primary haemorrhage was within 0 to 6.8 hours of surgery and the 95 per cent confidence interval (C.I.) of its upper limit was 5.2 to 8.4 hours. The results compare favourably with the UK inpatient and US adult day-case literature. We conclude that day-case tonsillectomy would probably be safe in adults if the patients are discharged after 8.4 hours.

Adolescent↗

PubMed1998

Admission and discharge policy for paediatric adenoidectomy and tonsillectomy--a rural perspective.

Adenoidectomy and tonsillectomy are amongst the most common surgical procedures carried out in children. We undertook a prospective audit in the Highlands of Scotland to document the views of general practitioners, parents, nursing staff and anaesthetists on admission and discharge policy. Of responses from 149 general practitioners, 119 (80 per cent) were in favour of change to same day admission and 22 (15 per cent) were not in favour. For change to same day discharge for adenoidectomy, 55 (37 per cent) were in favour and 81 (54 per cent) were not in favour. For change to next day discharge for tonsillectomy, the figures were 51 (34 per cent) and 89 (60 per cent) respectively. Responses from 14 trained paediatric nurses comprised 13 not in favour of same day admission, six in favour and seven not in favour of same day discharge for adenoidectomy and all 14 not in favour of same day discharge for tonsillectomy. All eight Consultant anaesthetists approached were happy with a change in policy to same day admission for children who were otherwise fit and well. Thirty-seven parents (70 per cent) preferred previous day admission and 14 (29 per cent) were happy with same day admission for their children. On the basis of these results, day-case adenoidectomy or tonsillectomy is not being considered in this area. Moves have been made, however, toward a policy of same day admission and next day discharge.

Adenoidectomy↗

PubMed1984

Post-operative haemorrhage in tonsillectomy and adenoidectomy in children.

A second anaesthetic for bleeding after adeno-tonsillectomy in children represents a significant hazard. The true incidence of this complication is assessed for over 20,000 operations. The incidence of bleeding after adeno-tonsillectomy was found to be the sum of bleeding post-adenoidectomy and post-tonsillectomy. Bleeding post-adenoidectomy is at least as common as post-tonsillectomy and both occur most frequently within 12 hours of operation. No reason for the bleeding occurring in these particular patients could be found.

Adenoidectomy↗

PubMed2006

Effect of tonsillectomy on recurrent sore throats in adults: patients' perspectives.

The aim of this study was to quantify the effect of tonsillectomy on the incidence of sore throats and its co-morbidity in adult patients. One hundred and nineteen adult patients were sent a standard questionnaire regarding their symptoms in the 12 months preceding and following their tonsillectomy. Outcome measures included the incidence of sore throats, total number of days with sore throat, amount of time taken off work or school, and number of visits to the general practitioner (GP). In addition, patients were asked to indicate the duration of their symptoms and whether or not they found the tonsillectomy effective in curing their sore throats. Sixty-six patients (55.5 per cent) returned completed questionnaires. The age of the patients ranged from 16 to 39 years. The mean duration of symptoms was 8.3 years. On average, patients had 8.1 different sore throat episodes, 42 sore throat days, 21.4 days of sore throat related absence from work or school, and 5.9 visits to the GP in the 12 months before their operation. For the 12 months after surgery, these reduced to 0.9 episodes, four days, 2.2 days and 0.6 visits, respectively. This reduction was very significant (p < 0.001, Wilcoxon signed rank test). After their surgery, more than half the patients achieved complete resolution of all the measured parameters mentioned above. Most of the remaining patients achieved at least 50 per cent resolution. Only three patients (4.8 per cent) achieved less than 50 per cent resolution. Ninety-five per cent of the patients found the operation effective in curing their sore throats and were glad they had had surgery. In conclusion, retrospective questionnaire data must be interpreted with some caution, but this study suggests that tonsillectomy is effective in reducing the incidence, duration and co-morbidity of recurrent sore throats in adults; this must be balanced against the post-operative problems in a minority of patients.

Adolescent↗