Tonsillectomy Procedures Research Articles

Instrumentation for officelaser surgery

Small, transportable 20 to 30 W TEM oo carbon dioxide lasers offer capability for performance of the largest number of ear, nose, and throat office procedures with a single laser. By combining sharp 200-μm size incision capability with dedicated focused handpieces and layer-by-layer char-free ablation of extended surfaces at low-power levels with the SwiftLase flashscanner technology, such important procedures as laser-assisted uvulapalatoplasty (LAUP), tonsil cryptolysis, lingual tonsillectomy, and other oral cavity procedures can be performed in the office. Treatments normally last a few minutes, using only local anesthesia. With the laser in the superpulse mode and the beam coupled to thin, 1-mm diameter waveguides (FlexiLase, Sharplan Lasers), char-free ablation of deep nasal lesions, such as hypertrophic turbinates, can also be achieved with minimal necrosis. A modified flashscanner technology can also be used in the office for skin resurfacing and hair transplant. Although less versatile and more expensive to buy and to operate, the Nd:YAG laser offers excellent ambulatory treatment of hypertrophic nasal turbinates. Noncontact Nd:YAG fibers can be used endoscopically for the treatment of nasal epistaxis and Nd:YAG contact technology can be used for the ablation of few highly vascular lesions.

Postoperative risks of pediatric tonsilloadenoidectomy.

Tonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement. The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possible 10 hours after surgery to minimize the risk of complications after discharge.

Factors in tonsillectomy mortality.

BISHOP 1 reported in 1946 that of 6,250 deaths occurring on the operating table, 542 (9%) were patients undergoing tonsillectomy. A recent survey on operative deaths in the pediatric age group by the Baltimore Anesthesia Study Committee revealed that tonsillectomy was the operative procedure resulting in the highest number of anesthesia deaths among children. 2 This study presents data accumulated by the Baltimore Anesthesia Study Committee on 17 operative deaths associated with tonsillectomy procedures and will evaluate primary and contributory factors that led to these deaths. Source of Material The Baltimore Anesthesia Study Committee is sponsored jointly by the Baltimore City Medical Society and the Baltimore City Health Department. Details on the organization of this committee have been reported in previous publications. 3,4 Briefly, all death certificates in Baltimore are reviewed by personnel of the Baltimore City Health Department, and where death occurred the day of or the day after