Palatine Tonsillectomy Research Articles

The Frequency of Lingual Tonsil Enlargement in Obese Children

Enlargement of the lingual tonsils is being increasingly recognized as a not uncommon and treatable cause of obstructive sleep apnea, particularly in patients with Down syndrome who have undergone palatine tonsillectomy and adenoidectomy. We have recognized an increasing number of patients who are obese and have obstructive sleep apnea with enlarged lingual tonsils. The purpose of this study was to evaluate the frequency of enlarged lingual tonsils in obese children. Seventy-one obese children (mean body mass index = 41.6 kg/m(2)) underwent sagittal fast spin-echo inversion recovery imaging. Lingual tonsils were identified and measured in the greatest anteroposterior diameter. Lingual tonsils > 10 mm were considered markedly enlarged. The subgroup with absent palatine tonsils (previous tonsillectomy) (n = 41) were compared with those with palatine tonsils present (n = 30). Forty-four (62%) of the obese children had measurable lingual tonsils, which is greater than the frequency previously reported in normal subjects (0%), subjects with obstructive sleep apnea (33%), or subjects with Down syndrome and obstructive sleep apnea (50%). Ten (14%) had lingual tonsils > 10 mm. Obese subjects with absent palatine tonsils (previous tonsillectomy) had a higher prevalence of measurable lingual tonsils than those with palatine tonsils (78% vs 22%, respectively; p < 0.001) and a higher prevalence of lingual tonsils > 10 mm (90% vs 10%, p < 0.001). Obese children have a high frequency of enlargement of the lingual tonsils with a significantly higher prevalence in those with previous tonsillectomy. Enlarged lingual tonsils may play a role in the pathogenesis of obstructive sleep apnea in obese children.

Statistical evaluation of the clinical pathway for a palatine tonsillectomy

Statistical evaluation of the clinical pathway for a palatine tonsillectomy

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls

Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome.

舌へん桃肥大による睡眠時無呼吸のダウン症例―代償性舌へん桃肥大における手術例―

We present an 11-year-old female with Down syndrome and moyamoya disease who underwent lingual tonsillectomy for obstructive sleep apnea syndrome. She had a palatine tonsillectomy and adenoidectomy at the age of 3 years and had another adenoidectomy for regrowth at the age of 9 years.At first examination, body mass index was 25.3. Physical examinations showed micrognathia, macroglossia, regrowth of adenoid and a remarkable lingual tonsillar hypertrophy. Her glottis was not inspected with the enlarged lingual tonsil. Preoperative polygraphy demonstrated that minimum value of SpO2 was 47%, %SaO2≤90% was 15.6%, and apnea index (AI) was 50.9 in 330 minutes of total sleep time.Lingual tonsillectomy was performed using an argon plasma coagulator as well as bipolar style electricity solidification. She had to be calmed postoperatively because of mental retardation and moyamoya disease. So nasotracheal intubation with propofol sedation was maintained for one week after the operation. She tolerated these procedures and her daily activity improved 7 months later. However, postoperative polygraphy exhibited no improvement in %SaO2≤90% or AI, with improvement in minimum value of SpO2.

Immune responses of palatine tonsil against bacterial antigens

Background: Although various bacterial antigens are frequently found in upper respiratory tract mucosal secretions, fatal responses, such as endotoxin shock, are rare, suggesting the presence of some regulatory system in mucosal as well as systemic tissues. In the present study, we examined the immune responses of tonsillar mononuclear cells against bacterial antigens. Materials and methods: Mononuclear cells were isolated from the palatine tonsils and peripheral blood (tonsil mononuclear cells [TNMC] and peripheral blood mononuclear cells [PBMC]) of patients who underwent palatine tonsillectomy. TNMC and PBMC were stimulated using lipopolysaccharide (LPS) or lipoteichoic acid (LTA) for 24 h, and cytokine production were determined by ELISA. Furthermore, the expression of Toll-like receptor (TLR) 4 and TLR2 on CD14 + and CD11c + cells were examined by FACS. Results: The production of TNFα, IL-1β, IL-6 and IL-8 from TNMC after stimulation with LPS or LTA were significantly lower than those from PBMC. Although CD11c + cells were observed in both TNMC and PBMC, the incidence of TLR4 or TLR2 expressing cells was lower in TNMC than in PBMC. Conclusions: Results suggest that the decreased expression of TLR4 and TLR2 in TNMC might be associated with the hyporesponses of palatine tonsils against LPS and LTA.

へん桃摘出術が著効を呈した潰よう性大腸炎例

Ulcerative colitis is an idiopathic, non-specific inflammatory disorder of the colon, and its etiology remains unknown. We present a case of ulcerative colitis in which clinical symptoms were remarkably improved by palatine tonsillectomy. The patient was diagnosed with severe ulcerative colitis and treated with internal medicine. When pharyngitis and aphthous stomatitis developed, his bowel symptoms worsened. A tonsillar provocation test was performed, and the result was positive. Moreover, bowel symptoms worsened after the tonsillar provocation test and the patient developed a sore throat and fever. Therefore, we suspected tonsillar focal infection and carried out palatine tonsillectomy. In the early postoperative period, bloody diarrhea recovered despite the interruption of sulfasalazopiridine and lymphocyte afferesis. In addition, recurrent pharyngitis and aphtous stomatitis were resolved entirely.

気管，食道周辺領域の粘膜免疫反応 咽頭・へん桃の感染に対する粘膜免疫応答

Adenoids and palatine tonsils are known to function as nasopharyngeal-associated lymphoreticular tissue for mucosal immune responses in the upper aerodigestive tract. In the present study, we investigated the immune responses of tonsillar lymphocytes in response to nontypeable Haemophilus influenzae (NTHi). Adenoids, palatine tonsils and nasopharyngeal secretions were obtained from patients who had undergone adenoidectomy or palatine tonsillectomy, and the numbers of NTHi in the samples were quantitated. The antibody activities against P6, one of the outer membrane proteins of NTHi, were determined by ELISA and the numbers of P6-specific antibody-producing cells were determined by ELISPOT. Production of cytokines from CD4+ T cells incubated with P6 was determined by ELISA and RT PCR. The results showed an increase of P6-specific IgA antibody activity and a decrease of NTHi in nasopharyngeal secretions with older age. The numbers of NTHi in the adenoids and the palatine tonsils decreased in samples having a large number of P6-specific IgA antibody-producing cells. CD4+ T cells more frequently produced Th2 type cytokines than Th1 type cytokines. The findings suggest that the adenoids and the palatine tonsils play an important role in regulating mucosal immune responses and the colonization of NTHi in the nasopharynx.

구개편도에 발생한 림프관종 2례

Benign tumors of the tonsil are relatively uncommon and the fewer are lymphangiomas. Recently, authors experiences the two cases of cavernous lymphangioma of the palatine tonsil. Removals of the tumor with palatine tonsillectomy were performed. The operations and the postoperative courses were uneventful and well. These cases report show its rarity through the reviews of literatures.

Changes in transaminase before and after tonsillectomy

Almost all patients who undergo palatine tonsillectomy for chronic tonsillitis and/or tonsillar hypertrophy manifest postoperative changes in their condition and laboratory data. In some patients, high preoperative transaminase levels decrease postoperatively. I studied 17 patients who had abnormal serum transaminase levels 10 days before tonsillectomy. Before tonsillectomy, serum glutamate oxaloacetate transaminase (GOT) levels were abnormal in half and serum glutamate pyruvate transaminase (GPT) were abnormal in all. Before operation, laboratory values of serum GPT were higher than those of serum GOT in all 17 patients. After tonsillectomy, the abnormal GOT levels in all patients gradually improved to the normal range before the 11th postoperative day and GPT levels did so before the 25th day. Measurement of intracellular transaminase activity of the palatine tonsil suggested that the migration of intracellular transaminase from tonsillar cells to serum would not elevate the serum transaminase level. Postoperative changes in serum transaminase and serum cholinesterase were different from the recovery process observed in fatty liver. The high transaminase level observed in patients with tonsillectomy is suspected to be due to other organs, rather than continuous inflammation of the palatine tonsil.

Laser surgical applications in tonsil and adenoid surgery: Pharyngeal and lingual

Removal of lymphoid tissue from the regions of the nasopharynx, pharynx, and hypopharynx, often referred to as adenoidectomy, palatine tonsillectomy, or just tonsillectomy and lingual tonsillectomy, is one of the most common operative procedures performed today. The majority of these procedures are performed by otolaryngologists, and these procedures account for about one third of all otolaryngology procedures done. As with any procedure, the surgeon wishes to perform the given task with as little injury and risk to the patient as possible. In this type of surgery these risks include damage to surrounding tissues, blood loss, postoperative pain, edema, and dehydration. Several surgical methods are available to help the surgeon try to accomplish this task, and one of the more popular methods today is laser-assisted excision. This discussion covers three separate surgical techniques and so will be divided into three sections. Each section will cover one of these techniques. Because much of the safety considerations and patient and room set up are common to these techniques, some of this information will not be repeated in all sections of the discussion.

口蓋へん桃摘出術後の鼻咽腔閉鎖不全症例

A 51-year-old man developed velopharyngeal insufficiency after palatine tonsillectomy. His preoperative velopharyngeal function was normal and he had none of the features of C alnan's triad that suggest submucous cleft palate or congenital velopharyngeal insufficiency.His velopharyngeal insufficiency was thought to be induced by adhesions between the lingual base and the anterior faucial pillars and cicatrication of the anterior faucial pillars. His velopharyngeal insufficiency was almost completely cured by resection of these scar tissues and covering the raw surface with a local buccal membrane flap.Velopharyngeal insufficiency induced by palatine tonsillectomy is very rare, but it is a possible complication of palatine tonsillectomy and must be taken into account.

Parotid fistula in children in the tropics

A study of 15 Nigerian children with parotid fistulae was carried out. The causes of the fistulae were found to be infection in nine children (60%), trauma in five (33.3%) and carcinoma in one (6.7%). The commonest infection was tuberculosis, with the primary site in the palatine tonsil and with associated tonsillar gland enlargement. In these cases there was no good response to tympanic neurectomy, surgical repair and anti-tuberculous therapy until palatine tonsillectomy was performed. It is therefore advised that the continued role of the tonsils as a primary site of tuberculous infection in the head and neck must always be sought, even in the management of parotid fistulae in children.

舌へん桃肥大に対するレーザー手術の適応

Thirteen patients with hypertrophied lingual tonsils were treated with laser surgery in the ENT department of Heidberg Hospital, Hamburg. Hypertrophy of the lingual tonsils probably develops as a compensatory enlargement following palatine tonsillectomy. It may be true that repeated infection (lingual tonsillitis) in younger patients participates in the development of lingual tonsil hypertrophy. CO2 laser surgery was used instead of surgical dissection with scissors or a tonsillotome. We conclude that CO2 laser application is a better treatment of hypertrophy of the lingual tonsil than earlier techniques since it causes minimal bleeding during surgery, only slight postoperative scarring, no damage to surrounding tissues and minor postoperative pain.