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

The authors measured the diameters of vessels around the surgical plane of tonsillectomy to investigate an anatomical basis to reduce hemorrhage. Thirty tonsils removed from 15 adult cadavers with the mean age of 56 years (range 44-71 years) at the time of death were studied. Calibration of the vessels across the tonsillar capsule was performed at the 1-mm intracapsular, capsular, and 1-mm extracapsular plane as artery and vein, respectively. The average diameter of the arteries was 73.0 +/- 33.1 mum at the 1-mm intracapsular plane, 94.7 +/- 33.5 mum at the capsular plane, and 139.5 +/- 51.2 mum at the 1-mm extracapsular plane. For the veins, it was 62.9 +/- 38.7 mum at the 1-mm intracapsular plane, 86.8 +/- 50.4 mum at the capsular plane, and 133.6 +/- 78.6 mum at the 1-mm extracapsular plane. The diameters of the vessels at the 1-mm intracapsular plane were significantly smaller than those at the capsular plane (P < 0.01), and likewise the diameters of the vessels at the capsular plane were significantly smaller than those at the 1-mm extracapsular plane (P < 0.01). The result of this study on the diameter of the vessels across the tonsillar capsule could be considered to be an important factor providing an anatomical rationale for a change in recommendation leading to safer tonsillectomies that minimize vascular injury.