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Radiofrequency tonsillotomy versus bipolar scissors tonsillectomy for the treatment of OSAS in children: a
S Morinière1, A Roux, D Bakhos
1Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital pédiatrique Clocheville, CHRU, 37044 Tours cedex 9, France. moriniere@med.univ-tours.fr
Insights
Radiofrequency tonsillotomy in children significantly reduces postoperative pain and bleeding compared to tonsillectomy. Both methods effectively treat obstructive sleep apnea syndrome (OSAS) with similar long-term efficacy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Tonsillar hypertrophy is a common cause of obstructive sleep apnea syndrome (OSAS) in children.
- Tonsillotomy is a recognized treatment option with potentially lower morbidity than tonsillectomy.
- Radiofrequency tonsillotomy (TT) and bipolar scissors tonsillectomy (TE) are surgical techniques for managing tonsillar hypertrophy.
Purpose of the Study:
- To compare the postoperative morbidity and short-term to intermediate-term efficacy of radiofrequency tonsillotomy (TT) versus bipolar scissors tonsillectomy (TE) in pediatric patients.
- To evaluate pain, postoperative complications, efficacy on OSAS, and operating times for both surgical techniques.
Main Methods:
- A prospective, non-randomized study included 193 children with OSAS due to tonsillar hypertrophy (excluding recurrent tonsillitis, clotting disorders, and age < 2 years).
- Patients underwent either radiofrequency tonsillotomy (TT) or bipolar scissors tonsillectomy (TE).
- Postoperative pain was assessed using the Postoperative Pain Measure for Parents score at specific intervals; complications and OSAS efficacy were also evaluated.
Main Results:
- The radiofrequency tonsillotomy (TT) group reported significantly lower pain scores during the first postoperative week compared to the tonsillectomy (TE) group.
- Secondary postoperative bleeding occurred less frequently in the TT group (1 case) than in the TE group (8 cases).
- No significant difference was found between TT and TE in terms of efficacy for treating OSAS, with a 4.5% tonsil regrowth rate in the TT group at 1 year.
Conclusions:
- Radiofrequency tonsillotomy is a safe and effective surgical option for treating obstructive tonsillar hypertrophy in children.
- TT offers the advantages of reduced postoperative pain and lower rates of bleeding compared to tonsillectomy.
- Both techniques demonstrate comparable efficacy in managing obstructive sleep apnea syndrome in the pediatric population.
Introduction:
Tonsillotomy is an effective treatment for the management of obstructive sleep apnoea syndrome (OSAS) in children with tonsillar hypertrophy and appears to be associated with less pain and postoperative morbidity.
Objective:
To compare postoperative morbidity and short-term and intermediate-term efficacy of radiofrequency tonsillotomy (TT) and bipolar scissors tonsillectomy (TE) in children.
Patients And Methods:
Children with OSAS due to tonsillar hypertrophy were included in a prospective, non-randomized study between February 4, 2008 and March 20, 2010. Exclusion criteria were recurrent tonsillitis (≥ 3 episodes per year), clotting disorders and age less than 2 years. Postoperative complications, efficacy on OSAS, and operating times were evaluated. Pain was evaluated by the Postoperative Pain Measure for Parents score on D0, D1, D7 and D30.
Results:
One hundred and ninety-three children were included: 105 in the TE group (age: 4.75 ± 2.37 years) and 88 in the TT group (age: 4.88 ± 2.6 years). The pain score was significantly lower in the TT group than in the TE group during the first postoperative week (P<0.05). A significant difference was observed for the secondary postoperative bleeding rate (1 after TT versus 8 after TE). No significant difference was observed between the two techniques in terms of the efficacy on OSAS. At 1 year, the tonsil regrowth rate in the TT group was 4.5%.
Conclusion:
Radiofrequency tonsillotomy is a safe technique for the treatment of obstructive tonsillar hypertrophy in children with good results on OSAS and a reduction of postoperative pain.
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