Tonsillectomy as prevention and treatment of sleep-disordered breathing: a report of 23 cases.

Jae-Man Woo,Jin-Young Choi

doi:10.1186/s40902-016-0092-y

Abstract

BackgroundThe paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients. This study has its purpose in sharing a series of tonsillectomies performed at the Seoul National University Dental Hospital for the treatment and prevention of SDB in adult patients.MethodsTotal of 78 patients underwent tonsillectomy at the Seoul National University Dental Hospital from 1996 to 2015, and 23 of them who were operated by a single surgeon (Prof. Jin-Young Choi) were included in the study. Through retrospective chart review, the purpose of tonsillectomy, concomitant procedures, grade of tonsillar hypertrophy, surgical outcome, and complications were evaluated.ResultsTwenty-one patients diagnosed with SDB received multiple surgical procedures (uvulopalatal flap, uvulopalatopharyngoplasty, genioglossus advancement genioplasty, tongue base reduction, etc.) along with tonsillectomy. Two patients received mandibular setback orthognathic surgery with concomitant tonsillectomy in anticipation of postoperative airway compromise. All patients showed improvement in symptoms such as snoring and apneic events during sleep.ConclusionsWhen only throat infections were considered, tonsillectomy was a procedure rather unfamiliar to oral and maxillofacial surgeons. With a shift of primary indication from recurrent throat infections to SDB and emerging technological and procedural breakthroughs, simpler and safer tonsillectomy has become a major tool in the multidisciplinary treatment modality for SDB.

Highlights

The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB)
Along with the primary indication shifting from recurrent throat infections to SDB, tonsillectomy has become a part of a multi-disciplinary treatment armamentarium of SDB therapies
Since SDB including obstructive sleep apnea syndrome (OSAS) is becoming a major topic in the field of oral and maxillofacial surgery, it is important to acknowledge the relationship between hypertrophic tonsils and SDB and to include tonsillectomy as the primary or adjunctive therapy in treating SDB patients

Summary

Introduction

The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). Along with the primary indication shifting from recurrent throat infections to SDB, tonsillectomy has become a part of a multi-disciplinary treatment armamentarium of SDB therapies. This report has its purpose in sharing accumulated data and experience on tonsillectomies performed in the Seoul National University Dental Hospital, Department of Oral and Maxillofacial Surgery, by a single surgeon from 2006 to 2015. Since SDB including obstructive sleep apnea syndrome (OSAS) is becoming a major topic in the field of oral and maxillofacial surgery, it is important to acknowledge the relationship between hypertrophic tonsils and SDB and to include tonsillectomy as the primary or adjunctive therapy in treating SDB patients

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