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Efficacy of partial tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome: a STROBE
T Banh Chong1, O Sagot1, M Alexis1
1Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier de Toulouse, Hôpital Larrey, 24, Chemin de Pouvourville, 31059 Toulouse cedex, France.
Insights
Partial tonsillectomy effectively reduces symptoms in children with Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis (PFAPA) syndrome. This procedure offers a lower complication risk compared to total tonsillectomy, though potentially less effective in symptom reduction.
Area of Science:
- Pediatric Otolaryngology
- Auto-inflammatory Diseases
- Surgical Outcomes
Background:
- PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis) syndrome is a common cause of recurrent fever in children.
- Frequent PFAPA episodes significantly impact children's quality of life and family functioning.
- While total tonsillectomy is effective, partial tonsillectomy's efficacy for PFAPA is less studied.
Purpose of the Study:
- To evaluate the postoperative course following partial tonsillectomy for PFAPA syndrome.
- To compare the outcomes of partial tonsillectomy with those of total tonsillectomy in PFAPA patients.
Main Methods:
- Retrospective cohort study adhering to STROBE guidelines.
- Inclusion of children diagnosed with PFAPA syndrome (EUROFEVER criteria) undergoing partial or total tonsillectomy.
- Data collected from January 2011 to December 2022 at a university hospital center.
Main Results:
- Partial tonsillectomy led to a significant reduction in annual PFAPA episodes (10 episodes/year, P<0.005) over 6 years.
- Symptom reduction was 50% with partial tonsillectomy versus 93% with total tonsillectomy (P=0.056).
- No complications were observed with partial tonsillectomy, compared to 10% in the total tonsillectomy group. 12.5% of partial tonsillectomy patients required conversion to total tonsillectomy.
Conclusions:
- Partial tonsillectomy significantly decreases the frequency, duration, and intensity of PFAPA episodes.
- Partial tonsillectomy may offer a safer alternative to total tonsillectomy due to a lower complication rate.
- Further investigation into partial tonsillectomy's long-term efficacy and potential for conversion to total tonsillectomy is warranted.
Introduction:
PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis) or Marshall syndrome is the most frequent cause of recurrent auto-inflammatory fever in children. Frequent episodes impair the child's quality of life and family life. Total tonsillectomy demonstrated efficacy in improving symptoms, but few studies assessed partial tonsillectomy in this indication. The aim of the present study was to assess postoperative course after partial tonsillectomy for PFAPA syndrome, with comparison to total tonsillectomy.
Materials And Methods:
This retrospective cohort study adhered to STROBE guidelines. It included children with PFAPA syndrome on EUROFEVER criteria, treated by partial or total tonsillectomy between January 1, 2011 and December 31, 2022 in our university hospital center. For comparisons, the significance threshold was set at P<0.005.
Results:
Thirty-six children were included: 16 with partial and 20 with total tonsillectomy. With partial tonsillectomy, the number of episodes decreased by 10 per year (range, 5-21) (P<0.005) over 6 years' follow-up. The decrease was 50% with partial tonsillectomy and 93% with total tonsillectomy (P=0.056). The decrease in number was statistically suggestive (P=0.028). There were no complications with partial tonsillectomy and 2 patients with complications (10%) with total tonsillectomy. Two of the 16 patients with partial tonsillectomy (12.5%) required totalization, achieving remission in both cases.
Conclusion:
Partial tonsillectomy significantly reduced the frequency, duration and intensity of postoperative episodes in PFAPA syndrome. It may be less effective than total tonsillectomy, but has a lower risk of complications awaiting remission in adolescence.
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