Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Sleep Medicine

Background:

• Adenotonsillar hypertrophy is a common cause of obstructive sleep apnea (OSA) in children.
• Surgical interventions aim to alleviate airway obstruction and improve quality of life.

Purpose of the Study:

• To compare intracapsular tonsillotomy using a microdebrider with extracapsular tonsillectomy for treating pediatric OSA related to adeno-tonsil hypertrophy.
• To evaluate surgical outcomes, including complications, symptom recurrence, and quality of life.

Main Methods:

• A retrospective study of 3127 children (3-12 years) with adeno-tonsil hypertrophy and OSA.
• Group A (1069 patients) underwent intracapsular tonsillotomy; Group B (2058 patients) underwent extracapsular tonsillectomy.
• Outcomes assessed included postoperative pain, bleeding, respiratory obstruction (via pulse oximetry), hypertrophy relapse, and quality of life (OSA-18 survey).

Main Results:

• Both surgical techniques led to significant improvements in obstructive respiratory symptoms and quality of life.
• Intracapsular tonsillotomy demonstrated reduced postoperative bleeding and pain compared to extracapsular dissection.
• No significant tonsillar regrowth was observed with the intracapsular technique over a one-year follow-up.

Conclusions:

• Intracapsular tonsillotomy with a microdebrider is an effective and safe procedure for pediatric OSA.
• This technique offers advantages such as decreased postoperative morbidity and quicker patient recovery.
• The microdebrider facilitates thorough tissue removal, preventing regrowth and ensuring sustained symptom relief.