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Published on: November 6, 2019
Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures.
L Di Rienzo Businco1, G Coen Tirelli
1Department of Otorhinolaryngology, S. Eugenio Hospital, Rome, Italy. ldirienzo@businco.net
Summary
Plasma tonsillectomy significantly improves post-operative recovery in children compared to cold dissection. This method reduces pain, analgesic use, and school absence, leading to faster recovery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Minimally Invasive Surgical Techniques
Background:
- Tonsillectomy is a common surgical procedure in children for chronic tonsillitis.
- Traditional cold dissection with suture ligatures can result in significant post-operative pain and prolonged recovery.
- Novel techniques aim to minimize patient discomfort and expedite recovery after tonsillectomy.
Purpose of the Study:
- To compare the post-operative recovery of pediatric patients undergoing tonsillectomy using a bipolar radiofrequency plasma device versus cold dissection.
- To evaluate key recovery parameters including pain, analgesic use, diet, fever, nausea, and school absenteeism over a 14-day period.
Main Methods:
- A comparative study involving 42 pediatric patients (aged 5-16) with chronic tonsillitis.
- Patients were randomized to tonsillectomy using either cold dissection with suture ligatures or a bipolar radiofrequency plasma device (Coblation, Evac 70).
- Post-operative recovery metrics were collected and analyzed using Kaplan-Meier curves and the Breslow (generalized Wilcoxon) test.
Main Results:
- Plasma tonsillectomy group reported significantly less pain on day one (1.2 vs. 3.5, p < 0.001).
- Patients in the plasma group experienced fewer days of pain (4.8 vs. 9.4, p < 0.001), reduced analgesic use (2.6 vs. 4.5, p < 0.001), and earlier return to liquid diet (5.1 vs. 8.5, p < 0.001).
- Fewer school days were missed in the plasma tonsillectomy group (5.3 vs. 8.9, p < 0.001).
Conclusions:
- Bipolar radiofrequency plasma tonsillectomy offers a superior post-operative recovery profile compared to cold dissection with suture ligatures in pediatric patients.
- The plasma device allows for simultaneous tissue excision and hemostasis, contributing to improved patient outcomes and quality of recovery.
- The study's findings led to the adoption of plasma tonsillectomy for the majority of cases.
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01:23Chronic Pharyngitis
Chronic pharyngitis refers to persistent inflammation of the pharyngial mucosa.
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...