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| |  AAO-HNSF: Partial Tonsillectomy For Sleep Disordered Breathing Promises Less Pain By Roberta Friedman, PhD Special to DG News SAN DIEGO, CA -- September 23, 2002 -- Surgery that only partially removes the tonsil but leaves its capsule intact is effective in treating sleep-disordered breathing in children but results in less postoperative pain than does standard tonsillectomy, say researchers. This finding was presented here yesterday at the 106th annual meeting of the American Academy of Otolaryngology and the Head and Neck Surgery Foundation. Peter Koltai, MD, from the Children’s Hospital, Cleveland Clinic, Cleveland, Ohio, United States, presented a retrospective review that compared all of the partial tonsillectomies performed at the clinic (243), to the total tonsillectomies (308) performed. The study subdivided data to look at the conventional tonsillectomies that were intended to treat obstructive sleep disordered breathing in children. Study analyses specifically excluded all conventional surgeries carried out in kids with tonsillitis. Chronic tonsillitis is a contraindication to the partial removal technique, Dr. Koltai said. Patient caregivers were contacted by phone to assess post-operative recovery (211 of partial tonsillectomies and 260 of total removals). Three surgeons performed the surgeries. In comparing the partial tonsillectomies to the standard surgeries, less pain, and quicker recovery to normal diet and activities resulted, with statistical significance achieved. Relief of apnea was obtained by both methods. A trend towards less bleeding after the partial removal was evident, "but our statisticians tell us that we will need 1000 kids to show statistical significance," Dr. Koltai said. One post-operative hemorrhage occurred in the partial removals, with four in the standard tonsillectomies. Mean recovery days were 3.9 for partials and 6.1 for standard surgeries (p<0.001). The partial removal, by debridement with an endoscopic microdebrider, purposefully preserves the capsule, Dr. Koltai said, which "leaves a biologic dressing on the pharyngeal musculature," preventing inflammation and infection. During the surgery, which takes three minutes more to perform than the conventional, total removal by electrocautery, fronds of connective tissue become evident "that tell you where to stop," he noted. "This is a technique that is truly going to revolutionize one of the most common operations we do," Dr. Koltai concluded. A randomized trial is needed to confirm the findings, he acknowledged.
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