title: Histologic assessment of thermal injury to tonsillectomy specimens: a comparison of electrocautery, coblation, harmonic scalpel, and tonsillotome.
abstract: OBJECTIVE
  To determine the extent of thermal injury to the tonsillar tissue following the use of various types of instrumentation. To determine if tonsillectomy specimens routinely contain tissue other than lymphoid tissue.
  
  
  METHODS
  Retrospective histologic analysis.
  
  
  METHODS
  A histologic analysis performed on 228 tonsillectomy specimens removed by use of an electrocautery in 132 specimens, harmonic scalpel in 46, coblation device in 24, and a tonsillotome in 26. The specimens were evaluated for presence and percentage of skeletal muscle and depth of thermal tissue injury.
  
  
  RESULTS
  The mean percentage of skeletal muscle present in the specimens was 0.79% for electrocautery, 1.74% for harmonic scalpel, 0.97% for coblation device, and 1.66% for the tonsillotome. Skeletal muscle was absent in only 8 of 228 specimens (3.5%). Electrocautery has a statistically significant (P < .05) lower percentage of muscle tissue compared to harmonic scalpel and the tonsillotome. There was no statistically significant difference in the mean depth of thermal injury among the harmonic scalpel (0.68 mm), electrocautery (0.58 mm), and coblation device (0.71 mm) specimens. The tonsillotome specimens had no thermal injury.
  
  
  CONCLUSIONS
  Attempts to remove the entire tonsil results in a similar depth of thermal injury to tonsillectomy specimens when using the harmonic scalpel, electrocautery, and coblation device. Skeletal muscle is a nearly ubiquitous finding in routine tonsillectomy specimens. The use of an electrocautery with a needle point may allow for a more precise dissection as it results in tonsillectomy specimens with a smaller percentage of muscle present.
authors.affiliation: Department of Otorhinolaryngology, Weill Cornell Medical College of Cornell University, New York, New York 10021, USA. vkm2001@med.cornell.edu
authors.forename: Vikash K
authors.initials: VK
authors.lastname: Modi
authors.forename: Hector
authors.initials: H
authors.lastname: Monforte
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Geller
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Koempel
mesh_terms: D002056:Burns / Q000209:etiology / Q000473:pathology*; D004564:Electrocoagulation / Q000009:adverse effects; D006801:Humans; D014066:Palatine Tonsil / Q000293:injuries* / Q000473:pathology*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects / Q000295:instrumentation*