Unilateral Tonsillectomy Research Articles

Complications of canine tonsillectomy by clamping technique combined with monopolar electrosurgery – a retrospective study of 39 cases

BackgroundCanine tonsillectomy is performed due to acute or chronic tonsillitis, neoplasia, trauma or occasionally brachycephalic obstructive airway syndrome. Several tonsillectomy techniques are used but information about surgical complications is scarce. This retrospective study of patient records at the University Animal Hospital aimed to investigate complications related to canine tonsillectomy performed by 20-min clamping combined with monopolar electrosurgery.Inclusion criteria were bilateral tonsillectomy performed with “20-min clamping technique combined with monopolar electrosurgery without suture or ligation”. Exclusion criteria were unilateral tonsillectomy, tonsillar neoplasia, additional surgical procedures other than tonsillectomy, cases where sutures were used initially, and cases where unspecified or other methods of tonsillectomy were used. The search of the patient records of the University Animal Hospital included a 10-year period. Complications that required additional anaesthesia were defined as major complications. Minor complications were handled during surgery or after surgery without surgical intervention.ResultsOf 39 dogs that fulfilled the inclusion criteria, 11 dogs had complications and out of those 1 dog had two complications. Altogether, of the 12 complications, 2 were classified as major complications and 10 as minor.The most frequent complication was bleeding from the surgical site, in total 11 incidences; 10 dogs had an incidence of bleeding and out of those, 1 dog bled twice, both during and after surgery. Of these 10 dogs that bled, seven incidences of bleeding occurred during surgery and four incidences occurred after surgery. The two dogs with major complications were re-anaesthetized due to bleeding after surgery. No lethal complications occurred and all dogs survived to discharge.ConclusionsBleeding during and after surgery was a common complication in dogs after bilateral tonsillectomy using “20-min clamping technique combined with monopolar electrocautery”. Revision intervention was often needed, sometimes urgently. Although no comparison was made with another technique, the studied technique should be used with caution.

Tonsillar neoplasm: experience of the 2nd Otorhinolaryngology Clinic from Cluj-Napoca

Introduction. The primary tonsillar neoplasm is a common malignancy of the head and neck, alcohol and/or cigarette smoke and Human Papilloma Virus is the main etiological agent. This study offers a retrospective analysis of the tonsillar neoplasm cases in a tertiary medical center from Romania. Patients and methods. We present a 4-year (2015-2018) retrospective study on 72 patients diagnosed with tonsillar neoplasm in our clinic, previously untreated patients. The study was included only the patients diagnosed through histopathological evaluation with tonsillar neoplasm. We searched the cases in our clinic database, and we collected data about age, gender, symptoms on admission, findings of the objective physical examination, oro-pharyngoscopy, medical imaging examination results, histopathological results, stage of the disease, therapeutic management. Results. The group composition is: 75% men and 25% women, 62.5% of them are smokers. Dysphagia/swallowing discomfort was the most common symptom identified, and the non-keratinized squamous cell carcinoma was the most common histopathological form. Stage I tonsil carcinoma was diagnosed in 25% of the cases, stage II in 15.3%, while 47.2% of the cases had stage III or IV. None of the patients presented distant metastases. Lymphoma was diagnosed in 12.5% of the cases. We performed for all patients in stages I and II underwent total unilateral tonsillectomy. For the patients in stages III and IV, we performed surgery after radiotherapy-chemotherapy treatment or only radiotherapy-chemotherapy. Conclusions. In Romania, smoking is still the most important risk factor for tonsil cancer. The majority of patients have visited a doctor only when dysphagia and, above all, palpable cervical adenopathy, were present, and the tumor was in the advanced stage. In Romania, the ENT-oncology integrated medical services are few, in most cases patients are lost from otorhinolaryngological follow-up.

Efficacy of Low-Temperature Plasma-Assisted Unilateral/Bilateral Tonsillectomy and Adenoidectomy in Children with Obstructive Sleep Apnea Hypopnea Syndrome.

BackgroundThe aim of this study was to investigate the efficacy of low-temperature plasma-assisted bilateral or unilateral tonsillectomy (LTPABT or LTPAUT) and adenoidectomy in treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS).Material/MethodsThe present observational cohort study included a total of 244 children with OSAHS during December 2017 to December 2018. The patients were divided into the LTPABT group, the LTPAUT group, and the control group that received traditional bilateral tonsillectomy and adenoidectomy. The apnea hypopnea index (AHI) and the lowest oxygen saturation (LSaO2) were measured. The patients’ pain condition was determined using the Visual Analog Score (VAS) and intraoperative indices were collected. Patients’ quality of life was assessed by OSA-18 scale and patients’ immune function was determined.ResultsThe postoperative VAS scores were remarkably lower in the LTPABT and LTPAUT groups. At 6 months after surgery, the AHI significantly had decreased and LSaO2 levels were significantly enhanced for all groups, and the AHI was significantly lower and LSaO2 was markedly higher in the LTPABT group. The ratio of patients with efficacy of cured and remarkably effective was remarkably higher in the LTPABT group. The rates of postoperative hemorrhage and infection were significantly lower in the LTPABT and LTPAUT groups, and 4 cases showed tonsillar hyperplasia. OSA-18 scores were lowest in the LTPABT group. No significant difference was found in levels of IgM, IgA and IgG, and T lymphocyte subtypes.ConclusionsThe low-temperature plasma-assisted bilateral tonsillectomy combined with adenoidectomy had the best efficacy. None of the surgery methods influenced the patients’ immune function.

Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?

<p class="abstract"><strong>Background:</strong> The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated. </p><p class="abstract"><strong>Results:</strong> A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.</p><p><strong>Conclusions:</strong> There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy. </p>

Outcomes after unilateral abscess tonsillectomy

Outcomes after unilateral abscess tonsillectomy

Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region.
 Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed.
 Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4. Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy).
 The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days.
 Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up.
 Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

Prevalence of synchronous bilateral tonsil squamous cell carcinoma: A retrospective study.

The prevalence of synchronous bilateral tonsil cancer remains unexplored. To date, only 38 cases have been described in the literature. With an aim to substantiate the Danish recommendation of performing bilateral tonsillectomy in patients with suspected or proven tonsil cancer and in patients with cervical carcinoma metastasis from an unknown primary tumour, this study was undertaken to determine the prevalence of synchronous bilateral tonsil cancer. A retrospective review of all patients diagnosed with tonsil cancer in the period 2000-2015, Aarhus University Hospital, Denmark, was performed. Seven of 211 (3.3%) consecutive patients with tonsil cancer, who had undergone bilateral tonsillectomy (n = 180) or unilateral tonsillectomy (clinically normal side) combined with contralateral tonsil biopsy (side with suspected cancer) (n = 31), had synchronous bilateral tonsil cancer. Furthermore, dysplasia was found in the contralateral tonsil in two patients with unilateral tonsil cancer. Four of 171 (2.3%) patients with suspected unilateral tonsillar cancer had additional contralateral tonsil cancer. Three of 34 (8.8%) patients without clinical signs of tonsillar malignancy on any side (32 patients with carcinoma of unknown primary) had synchronous bilateral tonsil cancer. In none of the patients were bilateral tonsil cancer suspected. Patients with unilateral vs synchronous bilateral tonsil cancer had similar clinical and tumour characteristics. Knowledge on additional contralateral synchronous tonsil cancer is crucial for avoidance of early recurrence of oropharyngeal cancer in patients with tonsil cancer. Based on our findings, we recommend bilateral tonsillectomy in all patients with suspected or proven tonsil cancer and carcinoma of unknown primary.

Decompression in Chiari Malformation: Clinical, Ocular Motor, Cerebellar, and Vestibular Outcome.

Treatment of Chiari malformation can include suboccipital decompression with resection of one cerebellar tonsil. Its effects on ocular motor and cerebellar function have not yet been systematically examined. To investigate whether decompression, including resection of one cerebellar tonsil, leads to ocular motor, vestibular, or cerebellar deficits. Ten patients with Chiari malformation type 1 were systematically examined before and after (1 week and 3 months) suboccipital decompression with unilateral tonsillectomy. The work-up included a neurological and neuro-ophthalmological examination, vestibular function, posturography, and subjective scales. Cerebellar function was evaluated by ataxia rating scales. Decompression led to a major subjective improvement 3 months after surgery, especially regarding headache (5/5 patients), hyp-/dysesthesia (5/5 patients), ataxia of the upper limbs (4/5 patients), and paresis of the triceps and interosseal muscles (2/2 patients). Ocular motor disturbances before decompression were detected in 50% of the patients. These symptoms improved after surgery, but five patients had new persisting mild ocular motor deficits 3 months after decompression with unilateral tonsillectomy (i.e., smooth pursuit deficits, horizontally gaze-evoked nystagmus, rebound, and downbeat nystagmus) without any subjective complaints. Impaired vestibular (horizontal canal, saccular, and utricular) function improved in five of seven patients with impaired function before surgery. Posturographic measurements after surgery did not change significantly. Decompression, including resection of one cerebellar tonsil, leads to an effective relief of patients' preoperative complaints. It is a safe procedure when performed with the help of intraoperative electrophysiological monitoring, although mild ocular motor dysfunctions were seen in half of the patients, which were fortunately asymptomatic.

Unilateral Pedunculated Polyp of the Palatine Tonsil

Objective: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.
 
 Methods:
 Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 
 Results: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without associated bleeding, pain, dysphagia or obstructive sleep apnea. Physical examination revealed a pedunculated mass about 2 x 1 x 0.5cm in size located in the superior pole. After unilateral tonsillectomy, histopathological examination revealed lymphangectatic lipomatous fibrotic polyp.
 
 Conclusion: Lymphangiomatous polyp of the palatine tonsils is an unusual benign lesion of the head and neck. These commonly present as unilateral, polypoidal mass that cannot be clinically differentiated from other benign tonsillar lesions. Tonsillectomy is the recommended surgical approach for both diagnostic and therapeutic purposes. Histopathological study must be done to confirm diagnosis.
 
 Keywords: Palatine Tonsil, Pedunculated polyp, Hamartoma, Lymphangioma, Tonsillectomy
 

A solitary tonsil can cause severe obstructive sleep apnea

Hypertrophy of the tonsils and adenoids is the most common cause of pediatric obstructive sleep apnea. Bilateral tonsillectomy, most commonly performed with adenoidectomy, is the accepted treatment for obstructive sleep apnea. We report the unusual case of a child who underwent unilateral tonsillectomy and adenoidectomy at another institution and subsequently presented to us with persistent severe obstructive sleep apnea and a diagnosis of attention deficit hyperactivity disorder. The adenoids were not obstructing the choanae. The remaining tonsil was removed and the patient's sleep apnea resolved. This is the first objectively documented report of a solitary tonsil causing severe obstructive sleep apnea (using polysomnography) that resolved after removal of the remaining tonsil.

Peritonsillar abscess: Treatment with immediate tonsillectomy – 10 years of experience

Conclusion: Immediate tonsillectomy in patients with peritonsillar abscess is a safe and effective treatment that should be considered as an alternative to conventional incision and drainage. Objective: To assess the efficacy, safety, and microbiology of immediate tonsillectomy over 10 years, in patients with peritonsillar abscess. Methods: This was a retrospective study. We reviewed the clinical charts of patients diagnosed with peritonsillar abscess in Clínica Las Condes from September 2000 to August 2010, who were treated with immediate unilateral or bilateral tonsillectomy. The patients' epidemiological information, antibiotic therapy, laterality of the surgery, results of microbiological cultures, complications, and recurrences were recorded. Results: A total of 112 patients were studied, with a mean age of 24 years. There were no events of sepsis, and there were only four cases (3.6%) of postoperative bleeding, two of which resolved spontaneously. Only 29% of the patients required morphine pump-based analgesia in the postoperative period. The mean length of hospital stay was 3.4 days. Among the 28 unilateral tonsillectomies, 4 (14.2%) developed streptococcal tonsillitis and 2 (7.1%) were readmitted with a contralateral peritonsillitis: one cellulitis and one abscess that required drainage and tonsillectomy. The most frequently isolated microorganisms were gram-positive bacteria (Streptococcus pyogenes and other streptococci) and anaerobic bacteria (mainly Bacteroides spp. and Fusobacterium nucleatum).

Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction

Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.

原発不明頚部転移癌の臨床的検討―治療後に原発巣が判明した症例を中心に―

Clinical features of 39 patients with cervical metastasis from unidentified primary carcinoma who underwent curative treatment at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital between 1980 and 2003 were reviewed. Thrity-nine (34 men and 5 women: mean age: 63 years) patients underwent radical treatment. The distribution of N classification in these cases was: N1 3, N2a 6, N2b 14, N2c 4, and N3 12. Histopathologically, 32 cases (82%) were squamous cell carcinoma, 5 cases (13%) were adenocarcinoma and 2 cases (5%) were undifferentiated carcinoma. After the initial treatment of the metastasic lesion, the primary lesions were confirmed in 12 cases (31%), two of which became evident at autopsy. In 10 cases, whose primary site were confirmed during post operative follow up, local control by additional therapy was successful in five cases (50%). In patients with upper or mid jugular lymph node metastasis, ipsilateral tonsillectomy was also performed in conjunction with neck dissection after 1998 and primary cancer was found in five of 14 patients (36%) post operatively. The overall 5-year survival rate as determined by the Kaplan-Meier method was 49%. The 5-year survival rate of 10 cases, in which the primary lesions were identified was 57%. The 5-year survival rate of 29 cases in which primary lesions remained unidentified was 46%. These results indicate the importance of accurate treatment of the metastatic neck nodes to improve survival in patients with unidentified primary carcinoma. We also propose screening unilateral tonsillectomy in patients with metastatic upper or mid jugular lymph nodes.

Hemorrhage in abscess tonsillectomy

Objectives: The goal of this study was to evaluate the incidence, side, and possible predictive factors of posttonsillectomy hemorrhage in abscess tonsillectomy. Methods: A retrospective study was performed on 150 patients who underwent abscess tonsillectomy under general anesthesia between 1995 and 2002. Nine patients were excluded from the study because only unilateral tonsillectomy was performed. Age, sex, recurrent tonsillitis, prior peritonsillar abscess history, bleeding disorders, current treatments (NSAID, aspirin, antibiotics), side of peritonsillar abscess, initial treatment (observation, needle drainage, surgical incision, tonsillectomy), surgeon’s experience, operative time, anti-inflammatory treatment peri- and postoperatively, bacteriology, systolic and diastolic blood pressure, side and postoperative day of hemorrhage, and management strategy were reviewed. Results: A total of 103 patients (73%) underwent abscess tonsillectomy within the first 24 hours. In the other 38 patients (27%), observation, needle aspiration or surgical drainage did not show any improvement of symptoms, and tonsillectomy was performed on days 2 to 5. Bleeding occurred in 18 patients (12.8%). Ipsilateral hemorrhage was observed in 5 patients (3.5%), and contralateral hemorrhage in 13 patients (9.3%). This is a nonsignificant trend for bleeding on the contralateral side( P = 0.08). Posttonsillectomy hemorrhage occurred after the fourth day in all these cases. Only aspirin intake was associated with increased posttonsillectomy hemorrhage ( P = 0.015). Conclusions: The risk of postoperative hemorrhage (12.8%) in abscess tonsillectomy seems higher than reported in elective tonsillectomy. The posttonsillectomy hemorrhage incidence could be reduced by excluding patients taking aspirin and by performing only ipsilateral abscess tonsillectomy.

Screening unilateral tonsillectomy in the unknown primary.

The LaryngoscopeVolume 105, Issue 5 p. 548-550 How I Do It Head And Neck And Plastic SurgeryFree Access Screening unilateral tonsillectomy in the unknown primary Paul D. Righi MD, Paul D. Righi MD Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, IndianapolisSearch for more papers by this authorRobert A. Sofferman MD, Corresponding Author Robert A. Sofferman MD Division of Otolaryngology—Head and Neck Surgery, University of Vermont College of Medicine, Burlington, VtUniversity of Vermont College of Medicine, Division of Otolaryngology—Head and Neck Surgery, One South Prospect St., Burlington, VT 05401Search for more papers by this author Paul D. Righi MD, Paul D. Righi MD Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, IndianapolisSearch for more papers by this authorRobert A. Sofferman MD, Corresponding Author Robert A. Sofferman MD Division of Otolaryngology—Head and Neck Surgery, University of Vermont College of Medicine, Burlington, VtUniversity of Vermont College of Medicine, Division of Otolaryngology—Head and Neck Surgery, One South Prospect St., Burlington, VT 05401Search for more papers by this author First published: May 1995 https://doi.org/10.1288/00005537-199505000-00021Citations: 44AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume105, Issue5May 1995Pages 548-550 ReferencesRelatedInformation

Peritonsillar abscess: Risk of disease in the remaining tonsil after unilateral tonsillectomy a chaud

Peritonsillar abscess: Risk of disease in the remaining tonsil after unilateral tonsillectomy a chaud

Peritonsillar abscess: Risk of disease in the remaining tonsil after unilateral tonsillectomy à chaud

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaud in the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.

Surgical relief of severe laryngeal malformation in an English Bulldog

A 22 month old English Bulldog was presented with progressive upper airway obstruction associated with an elongated soft palate, tonsillitis, everted laryngeal saccules and laryngeal malformation. Surgical management of the case consisted of resection of the elongated soft palate and everted laryngeal saccules, unilateral tonsillectomy and correction of the laryngeal stenosis. The latter was achieved by using a castellated incision through the laryngeal cartilages and first tracheal ring. From this case, it is postulated that, at least in some cases, the common upper airway obstruction syndrome in Bulldogs may not be due to laryngeal collapse as previously thought but rather to congenital malformation of the laryngeal cartilages.

Immunological basis of indications for tonsillectomy and adenoidectomy.

The tonsils are immune organs. The necessity for T & A should have a more rational approach for selected cases. The tonsils have a large immune function. The defense function of the tonsils is much greater in children than in adults. The children develop their resistance to infection by the time they are 7-8 years old. Tonsils and adenoids should not be removed below the age of eight unless there are absolute indications. Tonsillectomy has little or no effect on allergy. It is being done on account of tonsillar sepsis, and no other results are to be expected. In cases of obstructive tonsillar hypertrophy in young children, unilateral tonsillectomy is indicated. T & A are two separate operations, each with their own indications. Tonsillar focality could be regarded as a qualitative alteration in tonsillar antibody formation. The treatment of recurrent tonsillitis is related to the age of the patient. The solution to the problem up to an age of about 12 is quite different from that in older people. Alternatives to surgery are immunotherapy, intermittent chemotherapy and observation.

Immediate unilateral tonsillectomy for severe peritonsillar infections in children.

Twenty-four children with severe peritonsillar infections, subjected to unilateral tonsillectomies were studied with regards to the incidence of late infections in the remaining tonsil. Unilateral immediate tonsillectomy is an effective and sufficient treatment for unilateral peritonsillar abscesses in children or adolescents. The removal of the opposite uninvolved tonsil is not justified for it increases the risk of surgical morbidity, deprives the individual of an immunocompetent organ and does not result in demonstrable clinical benefit.