[Tonsil surgery: impact of the mouth gag on pharyngeal diameter]

Photo documentation of hypertrophic tonsils is requested by some insurance companies to justify reimbursement of tonsillotomy. In 2017, a standardized photo documentation was introduced in tonsillotomy patients to verify the indication and effectiveness of the procedure.

Using the archived photo documentation, this study aimed to evaluate the impact of two different positions of the mouth gag on the oropharyngeal airway.

Pictures were taken through the operating microscope after insertion of the mouth gag but without suspension (D1), after suspension before tonsillotomy (D2), and after resection of tonsillar tissue with the mouth gag under tension (D3). For each picture, a 10-mm scale from a single-use paper ruler was placed on the uvula. For this retrospective study, the patient's images were inserted into PowerPoint slides. Distances were measured with the use of an inserted rectangular grid.

The files of 149 patients undergoing tonsillotomy in a 6-month period were eligible for evaluation. Gender was balanced. The youngest patient was 16 months, the oldest patient 48 years old (mean: 6.95 years; median: 5 years). In all patients, tension of the mouth gag had significantly widened the oropharyngeal diameter (p < 0.001), making the tonsils appear smaller.

Suspension of the mouth gag results in a significant relative "downsizing" of the tonsils due to expansion of the oropharynx. Intraoperative photo documentation should also be performed without suspension of the mouth gag. Further studies may clarify whether stretching of the oropharynx has an impact on the distance between the tonsils and surrounding greater arteries.