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Can mucosal sealing reduce tonsillectomy pain?
Erkhan Genç1, Deniz Hanci, N Tan Ergin
1V.K.V. American Hospital ENT Clinic, Nişantaşi, Istanbul, Turkey. erkhangenc@hotmail.com
Insights
Sealing the tonsillectomy site with posterior pillar mucosa reduced pain in children after the third postoperative day. This technique improved healing but caused more edema, without affecting infection rates.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative pain and complications are significant concerns following tonsillectomy.
Purpose of the Study:
- To evaluate the efficacy of sealing the tonsillectomy field with posterior pillar mucosa in pediatric patients.
- To assess the impact of this technique on postoperative pain, healing, edema, and infection.
Main Methods:
- A prospective, randomized, single-blinded study involving 39 children aged 3-15 years.
- Tonsillar fossae were either covered with a mucosal flap or left as a control.
- Pain, healing, edema, and infection were assessed postoperatively using validated scales.
Main Results:
- Significantly lower pain scores were observed from postoperative Day 3 in the mucosal flap group (p<0.01).
- The mucosal flap side demonstrated better healing (p<0.01) but increased tissue edema (p<0.01).
- No significant difference in postoperative infection rates was found between the groups (p>0.01).
Conclusions:
- Sealing the tonsillectomy site with a mucosal flap effectively reduces postoperative pain in children.
- The technique promotes better wound healing but may increase local edema.
- Mucosal flap closure can be considered an adjunct to analgesics for managing pediatric tonsillectomy pain.
Objective/Hypothesis:
The hypothesis tests whether sealing the tonsillectomy field with posterior pillar mucosa can prevent unwanted outcomes in pediatric tonsillectomy.
Study Design:
A prospective, randomized, single blinded study was conducted on a sample of 39 children between 3 and 15 years of age. After dissection and snare tonsillectomy, the tonsillar fossa was covered on one side using the palatopharyngus mucosa and the other side is used as control. Pain scores, healing, edema and infection at the operation site were investigated.
Methods:
The tonsillectomy sites were randomly assigned into one of two groups. First group contained the ones with mucosal flap sealed over the operation site and the second group was kept as control with the operation site left uncovered. All of the patients received mild analgesics. The pain assessment is done on Days 1, 3, 5, 7 and 10 postoperatively, by using Wong-Baker faces visual analog scale. On the 10th postoperative day, the operation field of each side is scored separately for edema, healing and infection. Statistical investigation was performed through a software program.
Results:
On first postoperative day, pain level difference was not statistically significant between the two groups (p>0.01). But from 3rd to 10th postoperative day, the pain level was found out to be lower in the mucosa sealed site (p<0.01). On the 10th postoperative day, while the edema was significantly more (p<0.01), healing was better (p<0.01) at the sutured site. Postoperative infection at operation site was not different between the groups (p>0.01).
Conclusion:
Covering tonsillectomy field with mucosal palatopharyngeal arch flap significantly reduces pain after third postoperative day. The flap side had better healing when compared to denuded site. But the sutures in the mucosal flap may cause more tissue edema. Sutures have no significant effect on postoperative infection. Thus, mucosal flap may be used as an adjuvant surgical technique to decrease tonsillectomy pain of children in addition to the analgesic medication.
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