[Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results]. / Ambulant durchgeführte Diodenlasertonsillotomie bei symptomatischer Tonsillenhyperplasie des Kindes. Klinische Ergebnisse.

INTRODUCTION: The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia. METHOD: The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05). RESULTS: Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedure's effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5). CONCLUSION: Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.

Screening for oesophageal neoplasia in patients with head and neck cancer.

Due to advanced disease at the time of diagnosis the prognosis of oesophageal cancer is generally poor. As mass screening for oesophageal cancer is neither feasible nor reasonable, high-risk groups should be identified and surveilled. The aim of this study was to define the risk of oesophageal cancer in patients with (previous) head and neck cancer. A total of 148 patients with (previous) head and neck cancer were prospectively screened for oesophageal cancer by video-oesophagoscopy and random oesophageal biopsies. Even in a macroscopically normal looking oesophagus, four biopsy specimens were taken every 3 cm throughout the entire length of the squamous oesophagus. Low- or high-grade squamous cell dysplasia was detected histologically in 10 of the 148 patients (6.8%). All but one dysplasias were diagnosed synchronously with the head and neck cancers. In addition, oesophageal squamous cell carcinoma was diagnosed in 11 of the 148 patients (7.4%). Most invasive cancers (63.6%) occurred metachronously. The risk of squamous cell neoplasia of the oesophagus is high in patients with (previous) head and neck cancer. Surveillance is recommended in this high-risk group.