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Tonsillotomy: facts and fiction.

J P Windfuhr1, K Savva2, J D Dahm2

  • 1Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf Mönchengladbach, Sandradstr. 43, 41061, Mönchengladbach, Germany. jochen.windfuhr@mariahilf.de.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|April 4, 2014
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Summary
This summary is machine-generated.

Subtotal tonsillectomy (SIPT) and tonsillotomy (TT) offer less postoperative pain and faster recovery than total tonsillectomy (TE). Age and tonsillitis history are not contraindications, though more research is needed.

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Area of Science:

  • Otolaryngology
  • Surgical Oncology

Background:

  • Subtotal/intracapsular/partial tonsillectomy (SIPT) or tonsillotomy (TT) is associated with less postoperative morbidity compared to total or extracapsular tonsillectomy (TE).
  • Concerns exist regarding patient age, history of tonsillitis, and potential tonsillar regrowth or recurrent tonsillitis necessitating revision surgery.

Purpose of the Study:

  • To review and validate literature on indications, surgical techniques, complications, and outcomes of SIPT/TT since 1960.
  • To clarify contraindications and compare SIPT/TT with TE.

Main Methods:

  • A Medline literature review was conducted for English and German papers published up to September 30, 2013.
  • Studies were excluded if published before 1960, in other languages, unrelated to tonsil surgery, or lacking patient data.
  • Paper quality was assessed using The Oxford 2011 Levels of Evidence.

Main Results:

  • Microdebrider was the most utilized instrument, followed by Coblation, CO2-LASER, and others.
  • SIPT/TT showed advantages in operation time, reduced bleeding, quicker return to normal diet, and less analgesic intake.
  • Average rates of tonsillar regrowth and tonsillitis were <6%, with secondary surgery required in only one-third of these cases.

Conclusions:

  • Age >8 years and a history of tonsillitis are not absolute contraindications for SIPT/TT.
  • Strong evidence supports reduced pain and earlier return to normal diet and activity after SIPT/TT.
  • Further large, well-designed randomized controlled trials are needed to establish SIPT/TT as a replacement for TE in specific conditions.