Topical Triamcinolone on "Sweet Spots" to Block Dynamic Pain after Tonsillectomy and Uvulo-Palato-Pharyngo-Plasty.

Abstract

Severe pain on swallowing (or dynamic pain) has long been a problem in patients receiving tonsillectomy and uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome and/or snoring. We have previously verified that dynamic pain after laser-assisted uvulopalatoplasty could immediately be mitigated by local treatments with topical triamcinolone on the "sweet spots" of the wounds. This study aimed to assess the efficacy of applying triamcinolone on "sweet spot" in surgical incisions instead of whole surgical wounds to alleviate dynamic pain of some oropharyngeal surgeries such as tonsillectomy and uvulopalatopharyngoplasty. This study is a retrospective case series based on chart review of the participants. Forty-five subjects (31 males; 12~68 years, mean 34 years) with obstructive sleep apnea syndrome and/or snoring treated with tonsillectomy or uvulopalatopharyngoplasty were studied. Local treatments were done to sweet spots with triamcinolone on the 1st, 2nd, 3rd, and 7th days after the surgery. Evaluation of dynamic pain relief was performed by using a visual analogous scale. Sweet spots treatment led to instantaneous reduction of dynamic pain. The average improvement level was ≥72% (P ≤ .002). No gender effect was noted. Dynamic pain after tonsillectomy and uvulopalatopharyngoplasty could immediately be mitigated by local treatments upon sweet spots. Local treatments upon sweet spots were highly suggested to begin early post-operatively and be included in the take-home routines for patients receiving tonsillectomy and uvulopalatopharyngoplasty.