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Partial tonsillectomy with scalpel in children with obstructive tonsillar hypertrophy
Omer Korkmaz1, Devrim Bektas, Bengu Cobanoglu
1Department of Otolaryngology, KTU Medical School, Trabzon, Turkey.
Insights
Partial tonsillectomy (PT) with a scalpel reduces postoperative pain and analgesic use in children compared to total tonsillectomy (TT). This safe, cost-effective method is ideal for obstructive tonsillar hypertrophy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Techniques
Background:
- Obstructive tonsillar hypertrophy is a common condition in children requiring surgical intervention.
- Tonsillectomy is a standard procedure, but postoperative pain remains a significant concern.
- Comparing surgical techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare postoperative pain and analgesic requirements between partial tonsillectomy (PT) using a scalpel and total classical tonsillectomy (TT).
Main Methods:
- A prospective, randomized study involving 96 children with obstructive tonsillar hypertrophy.
- Children underwent either PT with scalpel and tissue scissors or TT via classical dissection.
- Postoperative pain was assessed daily for nine days using analgesic dosage and Visual Analog Scale (VAS) scores.
Main Results:
- Eighty-one children completed the study; 41 in the TT group and 40 in the PT group.
- No significant differences were observed in operative time or blood loss between the groups.
- The PT group required significantly less daily and total analgesic dosage compared to the TT group (p<0.005).
- Pain scores did not differ significantly between the two techniques (p>0.05).
Conclusions:
- Partial tonsillectomy (PT) with a scalpel is a safe, inexpensive method for treating obstructive tonsillar hypertrophy in children.
- PT results in significantly less postoperative pain and reduced analgesic requirements compared to total tonsillectomy (TT).
- This technique necessitates only standard surgical instruments, making it widely accessible.
Objective:
To compare postoperative pain of partial tonsillectomy (PT) with scalpel and total classical tonsillectomy (TT).
Methods:
Prospective, randomized study at a tertiary care institution. Ninety-six children who were diagnosed with obstructive tonsillar hypertrophy were included to the study. Children's tonsils were removed totally (Group TT) by classical dissection tonsillectomy or partially (Group PT) using scalpel and tissue scissors. The parents were instructed to fill out a form daily for nine postoperative days; recording total amount of analgesics administered that day and a Visual Analog Scale (VAS) each day assessing child's life quality and daily activities.
Results:
Eighty-one children (2-14 years old) who completed the study were included in the analysis. Total tonsillectomy group (Group TT) consisted of 41 patients and partial tonsillectomy group (Group PT) consisted of 40 patients. There was no difference between two groups' operative parameters such as operation time [21.3 min (PT) and 22.3 min (TT)] and blood loss [44.2 ml (PT) and 46.0 ml (TT)] (p>0.05). PT group received significantly less dosage of analgesics per day; 1.18+/-1.27 vs. 2.00+/-1.45 (p<0.005). Total used analgesic dose in PT group were also lower than TT group (10.7+/-7.13 vs. 18.02+/-6.99 doses). When each day's analgesic use was compared separately a significant difference was found (p<0.05) in all days except 9th postoperative day (p>0.05). There was no difference in the pain scores between two techniques (p>0.05).
Conclusion:
Unlike tonsillectomy, PT aims to remove the tonsilla palatina subtotally. It is especially performed in children with obstructive tonsils. PT with scalpel is an inexpensive and safe method necessitating only standard surgical instruments. It causes less postoperative pain than classical dissection tonsillectomy.
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