Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children.
OBJECTIVE
We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery.


METHODS
We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB.


RESULTS
Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery.


CONCLUSIONS
Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.
Koltai
Peter J
PJ
Section of Pediatric Otolaryngology, The Children's Hospital at the Cleveland Clinic Foundation, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA. koltaip@ccf.org
Solares
C Arturo
CA
Koempel
Jeffery A
JA
Hirose
Keiko
K
Abelson
Tom I
TI
Krakovitz
Paul R
PR
Chan
James
J
Xu
Meng
M
Mascha
Edward J
EJ
D002648:Child; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000473:pathology / Q000601:surgery; D008297:Male; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D014066:Palatine Tonsil / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*