Tonsillectomy versus tonsillotomy for obstructive sleep-disordered breathing in children

Abstract

BackgroundObstructive sleep-disordered breathing (oSDB) is a condition encompassing breathing problems when asleep due to upper airway obstruction. In children, hypertrophy of the tonsils and/or adenoids is thought to be the commonest cause. As such, (adeno)tonsillectomy has long been the treatment of choice. A rise in partial removal of the tonsils over the last decade is due to the hypothesis that tonsillotomy is associated with lower postoperative morbidity and fewer complications. ObjectivesTo assess whether partial removal of the tonsils (intracapsular tonsillotomy) is as e ective as total removal of the tonsils (extracapsular tonsillectomy) in relieving signs and symptoms of oSDB in children, and has lower postoperative morbidity and fewer complications.

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

“…Partial tonsillectomy, also called tonsillotomy, is becoming more frequent in Sweden and has shown good treatment results 129,132 . Children seem to return faster to normal activity after tonsillotomy compared to tonsillectomy; nevertheless, the long-term effect and need for repeated surgery is still uncertain 133 . Children with non-severe OSA who receive intranasal steroids and leukotriene antagonists have shown improvement in their PSG parameters as well as their QoL [134][135][136] .…”

Is Postextracapsular Tonsillectomy Bleeding More Common on the Side of the Surgeon’s Nondominant Hand?

“…10 In these cases, tonsillectomy is usually associated with a higher risk of postoperative bleeding. 11 In the current study, 109 patients (58.6%) had one of the aforementioned indications. This further confirms the higher bleeding risk following surgery on inflamed tonsils.…”

Paediatrics: how to manage obstructive sleep apnoea syndrome

“…Intracapsular tonsillectomy or tonsillotomy with partial resection of tonsils instead of the classical complete tonsillectomy is becoming more commonly used for the treatment of children with SDB. 55 Some studies showed that tonsillotomy resulted in a faster recovery and slightly lower risk of postoperative complications of bleeding and pain. However, more robust data from high-quality and long-term studies are needed to confirm its effectiveness and the risk of recurrence.…”

“…However, more robust data from high-quality and long-term studies are needed to confirm its effectiveness and the risk of recurrence. 55 Children with risk factors for postoperative complications include young age less than 3 years, severe OSAS with an AHI score of >20 events per hour, cardiac complications, obesity, pre-existing structural comorbidities, or concurrent respiratory infections and should be subjected to at least a period of overnight in-patient observation postoperatively. 1 , 10 Adiposity and elevated leptin in obesity may also affect the metabolism of analgesic drugs such as morphine during postoperative care.…”