Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy

Lee, Kang‐Dae; Lee, Hyoung-Shin; Hong, Jong-Chul; Yu, Tai-Hyun; Lee, Hwan-Ho; Chun, Bong-Gwon; Gil, Young-Gi; Kim, Kyoung-Sook

doi:10.1002/ca.20562

Cited by 30 publications

(21 citation statements)

References 21 publications

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“…12 Our higher rate for MET in adults may be secondary to the larger surface area of the tonsillar fossae and larger vessels in adults. 13 An additional factor is our low threshold to reoperate rather than observe in patients who present to the emergency room with hemorrhage.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults

Johnston

Gaslin

Boon

et al. 2010

Ann Otol Rhinol Laryngol

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Objectives This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET). Methods In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both). Results In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery. Conclusions Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.

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Section: Resultsmentioning

confidence: 99%

Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults

Johnston

Gaslin

Boon

et al. 2010

Ann Otol Rhinol Laryngol

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“…The size of the exposed vessels in the tonsillar fossae was not assessed in the present study. The diameter of the tonsillar vessels decreases as the vessels go from the extracapsular plane to the intracapsular plane [33]. The density of vasculature in the dissection plane may influence intraoperative blood loss as well as the number of vessels exposed after removal of tonsils.…”

Section: Discussionmentioning

confidence: 99%

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

Ulualp

2011

Eur Arch Otorhinolaryngol

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The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6-13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.

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“…In contrast to extracapsular tonsillectomy, the tonsillar capsule and extracapsular vessels are not injured by IDTT. Early bipolar coagulation of bleeding intratonsillar vessels will therefore not result in bleeding complications due to their small diameter [20]. This statement is supported by the fact that several 3-min IDTTs were performed by the senior author.…”

Section: Discussionmentioning

confidence: 87%

Cranial tonsillotomy for peritonsillar abscess: what a relief!

Windfuhr

Nematian

Ziogou

2016

Eur Arch Otorhinolaryngol

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Peritonsillar abscess (PTA) is a common infection of the oropharynx resulting in painful swallowing, sometimes associated with fever, trismus and a typical voice alteration. Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy. However, a gold standard of surgical therapy still does not exist. The aim of this study was to evaluate the outcome in patients who had undergone ID supplemented by cranial tonsillotomy (IDTT) as first-line treatment. A retrospective chart review of all patients who had undergone IDTT at our department in 2015 was performed. Demographic data, clinical findings, pain intensity on a 10-point visual analog scale, operation time and routine bloods before and after IDTT were collected. In addition, a 10-point visual analog scale (VAS) was utilized to measure personal satisfaction 2 weeks and 2 months after surgery. A total of 104 procedures were performed in 65 male and 38 female patients (median age 35 years), including one patient with a contralateral PTA 2 weeks after IDTT. Three patients had experienced abscess formation after admittance for antibiotic treatment of acute tonsillitis. 57.7 % of all patients denied intake of antibiotic therapy in their history at initial presentation. Patients were hospitalized for 3 days (median). The median pain intensity (VAS) within the first three postoperative days was 2, 1 and 1, respectively. Two weeks and 2 months after surgery patients were highly satisfied with the procedure (median value 10). Bleeding complications did not occur. IDTT is a novel surgical concept and associated with great patient comfort. It is safe, easy to learn and associated with an early return to normal diet and physical activity. These findings are supported by a rapid normalization of white blood cell count and C-reactive protein. IDTT eliminates the necessity of painful re-draining of the wound cavity and is free of bleeding complications. In contrast to ID and NA, histological examination of tonsillar tissue is feasible to disclose a previously undetected malign disease. Further analysis is warranted to verify the success rate in the long-term.

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Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy

Cited by 30 publications

References 21 publications

Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults

Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

Cranial tonsillotomy for peritonsillar abscess: what a relief!

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