The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children

Jeffrey A. Koempel, Clementino Arturo Solares, P. J. Koltai

Research output: Contribution to journalReview article

46 Citations (Scopus)

Abstract

Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

Original languageEnglish (US)
Pages (from-to)993-1000
Number of pages8
JournalJournal of Laryngology and Otology
Volume120
Issue number12
DOIs
StatePublished - Dec 1 2006

Fingerprint

Palatine Tonsil
Sleep Apnea Syndromes
Tonsillectomy
Hypertrophy
Research
Morbidity
Pain
Infection
Surgeons

Keywords

  • Otorhinolaryngologic Surgical Procedures
  • Sleep Apnoea Syndromes
  • Tonsillectomy
  • Tonsillotomy, partial tonsillectomy, partial intracapsular tonsillectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children. / Koempel, Jeffrey A.; Solares, Clementino Arturo; Koltai, P. J.

In: Journal of Laryngology and Otology, Vol. 120, No. 12, 01.12.2006, p. 993-1000.

Research output: Contribution to journalReview article

Koempel, Jeffrey A. ; Solares, Clementino Arturo ; Koltai, P. J. / The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children. In: Journal of Laryngology and Otology. 2006 ; Vol. 120, No. 12. pp. 993-1000.
@article{e75fd24ba38041b8ae52bf9578f7637f,
title = "The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children",
abstract = "Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.",
keywords = "Otorhinolaryngologic Surgical Procedures, Sleep Apnoea Syndromes, Tonsillectomy, Tonsillotomy, partial tonsillectomy, partial intracapsular tonsillectomy",
author = "Koempel, {Jeffrey A.} and Solares, {Clementino Arturo} and Koltai, {P. J.}",
year = "2006",
month = "12",
day = "1",
doi = "10.1017/S0022215106002544",
language = "English (US)",
volume = "120",
pages = "993--1000",
journal = "Journal of Laryngology and Otology",
issn = "0022-2151",
publisher = "Cambridge University Press",
number = "12",

}

TY - JOUR

T1 - The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children

AU - Koempel, Jeffrey A.

AU - Solares, Clementino Arturo

AU - Koltai, P. J.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

AB - Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.

KW - Otorhinolaryngologic Surgical Procedures

KW - Sleep Apnoea Syndromes

KW - Tonsillectomy

KW - Tonsillotomy, partial tonsillectomy, partial intracapsular tonsillectomy

UR - http://www.scopus.com/inward/record.url?scp=33846401406&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846401406&partnerID=8YFLogxK

U2 - 10.1017/S0022215106002544

DO - 10.1017/S0022215106002544

M3 - Review article

C2 - 16923328

AN - SCOPUS:33846401406

VL - 120

SP - 993

EP - 1000

JO - Journal of Laryngology and Otology

JF - Journal of Laryngology and Otology

SN - 0022-2151

IS - 12

ER -