Tonsillotomy

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As Tonsillectomy is called the operative part removal of the tonsils .

The procedure is mainly performed on children between the ages of 2 and 8 and is an alternative to tonsillectomy , the complete removal of the tonsils in the event of significant tonsil enlargement, which is often associated with impaired breathing, swallowing and / or nocturnal pauses in breathing. It can be performed with different surgical instruments such as the laser , the monopolar needle, the ultrasonic knife, the scissors or by means of high frequency ablation . The main advantage over tonsillectomy is the very low rebleeding rate. Therefore, the procedure is mostly performed on an outpatient basis.

In the case of chronic tonsillitis ( chronic tonsillitis ) or frequent acute tonsillitis (recurrent tonsillitis), a contraindication to tonsillotomy was previously considered, as further inflammations or scarring changes in the residual tonsil, resulting in (dangerous) abscesses were assumed. In these cases, the traditional tonsillectomy with an inpatient stay of up to a week was the treatment of choice. However, extensive studies have not been able to confirm abscesses in the remaining tonsil tissue as a typical complication. Recently, therefore, the expansion of the indication for tonsillotomy in children and adolescents has also been described for recurrent and chronic tonsillitis. According to the guidelines of the AWMF ( Working Group of Scientific Medical Associations eV) for the treatment of inflammatory diseases of the tonsils, tonsillotomy is also an adequate treatment method for recurrent tonsillitis in adulthood. Although tonsillotomy leaves tonsillotomy, tonsillotomy has shown a reduction in annual sore throat episodes in adolescents and adults that does not differ from the rate of reduction after conventional tonsillectomy.

There are reasons to take a critical look at these guidelines of the AWMF, according to which tonsillotomy is an adequate treatment method compared to tonsillectomy. Because there are no long-term studies of the complication rates after tonsillotomy. So far, the follow-up times for this surgical procedure have only been 1 to 3 years. This time is not sufficient to rule out any complications that may arise later, in particular recurrent residual tonsillitis. It is not certain whether the removal of parts of the tonsil removes the tissue to such an extent that the tonsil crypts as a potential reservoir of detritus and pathogens that cause disease have been completely removed. If parts of the crypts remain, from a pathological-anatomical point of view there may be cicatricial occlusions on the surface of the same, whereby the formation of tonsil abscesses cannot be ruled out for the time being. The Institute for Quality and Efficiency in Health Care (IQWiG) comes to a similar conclusion. After that, the tonsillotomy is associated with less pain as well as swallowing and sleeping disorders within the first two weeks. However, tissue that grows back after a tonsillotomy can have disadvantages: even years after a tonsillotomy, inflammation of the tonsils can occur again, which can make another operation necessary. When weighing up the benefits and harms of tonsillotomy compared to tonsillectomy, there is a short-term reduction in procedural side effects and, in the long term, a potentially lower benefit.

literature

Hans Peter Zenner: Practical therapy of ENT diseases . 2nd edition 2008; Schattauer, Stuttgart

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