Bipolar-assisted tonsil reduction: a simple and inexpensive tonsillotomy technique

Clinical Research ENT Updates 2018;8(1):51–55 doi:10.2399/jmu.2018001002 Bipolar-assisted tonsil reduction: a simple and inexpensive tonsillotomy technique Kadir Ça¤dafl Kaz›kdafl, Mustafa As›m fiafak Department of Otorhinolaryngology, Faculty of Medicine, Near East University, Nicosia, TRNC Abstract Özet: Bipolar-destekli tonsil küçültme: Basit ve düflük maliyetli bir tonsillotomi tekni¤i Objective: This study aims to investigate the novel use of a simple and inexpensive bipolar-assisted tonsil reduction (B-TR) technique in pediatric cases with adenotonsillar hyperplasia by evaluating long-term results, possible complications, need for reoperation and incidence of recurrence. Amaç: Bu çal›flmada, adenotonsiller hiperplazisi olan pediatrik olgularda basit, ucuz ve yeni bir yöntem olarak bipolar-destekli tonsil küçültme (BTK) tekni¤inin, uzun dönem sonuçlar›n›, olas› komplikasyonlar›n›, revizyon cerrahisi ihtiyac›n› ve rekürrens insidans›n› de¤erlendirerek klinik kullan›m›n› araflt›rmay› amaçlad›k. Methods: We present our long-term retrospective data from 78 consecutive pediatric cases undergoing B-TR combined with adenoidectomy from April 2013 to January 2017. The tonsillar sizes were recorded using the Brodsky grading scale from I to IV, and the patients only with prominant tonsillar sizes (III and higher) and adenoidal sizes exceeding 50% were included in the study group. The tonsil sizes were noted preoperatively, and during the latest follow-up visit after tonsillotomy (min. 9 months postoperatively). Yöntem: Nisan 2013 ile Ocak 2017 aras›ndaki periyotta adenoidektomi ile birlikte BTK uygulanan ard›fl›k 78 çocuk hastam›zdan elde etti¤imiz uzun dönem retrospektif verilerimizi sunmaktay›z. Tonsil boyutlar›, I’den IV’e kadar Brodsky dereceleme skalas› kullan›larak kaydedildi ve sadece belirgin derecede hipertrofik tonsilleri olan (III ve üstü) ve adenoid boyutlar› %50’yi aflan hastalar çal›flma grubuna dahil edildi. Tonsil boyutlar› preoperatif olarak ve tonsillotomi sonras›ndaki en son takip s›ras›nda (postoperatif min. 9 ay) dosyalar›na kaydedildi. Results: With a mean follow-up period of 18.3 months, the mean tonsillar size preoperatively was 3.47 (±0.50) and mean tonsillar size postoperatively was 1.35 (±0.48). A significant difference (p<0.001) was observed between these two groups, excluding the only case who later had undergone tonsillectomy. Minimal uvular edema was noted in 27 children (34.6%), which did not cause any upper airway obstruction in these patients. Bulgular: Ortalama 18.3 ayl›k izlem süresi sonras›nda, operasyon öncesi ortalama tonsil büyüklü¤ü 3.47 (±0.50), operasyon sonras› ortalama tonsil boyutu ise 1.35 (±0.48) olarak kaydedildi. Daha geç dönemde klasik tonsillektomi uygulanan bir hastam›z ç›kar›ld›¤›nda, bu iki grup aras›nda istatistiksel aç›dan anlaml› bir fark saptand› (p<0.05). 27 çocukta (%34.6) minimal uvula ödemi gözlendi, ancak bu durum hastalarda herhangi bir üst hava yolu obstrüksiyonuna neden olmad›. Conclusion: We describe herein our B-TR technique in details so that it can be learned relatively quickly and used in pediatric cases with adenotonsillar hyperplasia as a treatment option. Sonuç: Bu çal›flma sayesinde BTK tekni¤imizi, adenotonsiller hiperplazisi olan pediatrik olgularda, nispeten kolayl›kla ö¤renilebilen ve uygulanabilen bir tedavi seçene¤i olarak ayr›nt›l› olarak tarif etmeyi planlad›k. Keywords: Tonsillotomy, tonsillectomy, bipolar diathermy, tonsil reduction. Anahtar sözcükler: Tonsilotomi, tonsillektomi, bipolar diatermi, tonsil küçültme. Tonsillectomy is the most common major otolaryngological procedure performed in pediatric age group, alone or combined with adenoidectomy. Absolute indications for tonsillectomy and adenoidectomy include adenotonsillar hyperplasia with obstructive sleep apnea, failure to thrive, abnormal dentofacial growth; suspicion of malignant disease; acute rheumatic fever or (for tonsillectomy) hemorrhagic tonsillitis.[1] The two major criteria that are most commonly considered to justify surgical intervention are sleep-disordered breathing and recurrent throat infections Correspondence: Kadir Ça¤dafl Kaz›kdafl, MD. Department of Otorhinolaryngology, Faculty of Medicine, Near East University, Nicosia, TRNC. e-mail: Received: February 17, 2018; Accepted: March 12, 2018 ©2018 Continuous Education and Scientific Research Association (CESRA) Online available at: www.entupdates.org doi:10.2399/jmu.2018001002 QR code: Kaz›kdafl KÇ, fiafak MA which have a significant impact on children’s health and life quality. Hence, adenotonsillectomy for the treatment of adenotonsillar hyperplasia in children is currently the most common indication in our practice. Typical and classical type of surgery in such cases is “extracapsular” tonsillectomy, where the tonsillar tissue and its fibrous capsule coverings are separated from the pharyngeal constrictor muscle as a whole. Exposed peritonsillar tissue containing vessels and muscle fibers can cause significant postoperative pain. Trauma to large extracapsular vessels can result in profuse hemorrhage, with risks of transfusion, further emergent procedures and, in rare cases, even death.[2] In order to decrease the complications and postoperative morbidities, there has been an increasing attention drawn to “intracapsular” tonsillectomy or tonsillotomy lately where the lateral portion of the tonsil and its capsule are preserved.[3] Various methods have been described in the literature and yet there is no consensus on which is the most convenient method, with the most commonly used ones today: radiofrequency, microdebrider, CO2 laser, thermal welding, bipolar scissors and coblation.[3,4] Despite the reduction in complications due to these techniques, most employ relatively expensive equipment. Herein, we describe the novel use of our simple and inexpensive bipolar-assisted tonsil reduction (B-TR) technique in 78 consecutive pediatric cases with adenotonsillar hyperplasia by evaluating long-term results, possible complications, need for reoperation and incidence of recurrence. Materials and Methods Patients This is a retrospective chart review of the operated children suffering from snoring and obstructive symptoms due to adenotonsillar hyperplasia with no history of recurrent tonsillitis, who had been referred to our ENT department between April 2013 and January 2017. 78 children (52 f, 26 m) with tonsillar hyperplasia, aged 3–11 (mean age 7.2±2.4) years were included in this study. Exclusion criteria were recurrent tonsillitis, neoplasia, history of peritonsillar abscess or previous tonsillar surgery, comorbidities such as obesity, severe OSA, bleeding disorders and systemic diseases such as pulmonary, cardiac or metabolic abnormalities. Children with elevated titers of anti-streptolysine O, C-reactive protein or rheumatoid factor, and a positive throat culture for group A beta-hemolytic streptococci were also excluded from the study group. Parents were in (...truncated)