Coblation intracapsular tonsillectomy in a paediatric tertiary centre: Revision surgery rates over a nine-year period.

OBJECTIVES: Coblation intracapsular tonsillectomy (ICT) is increasingly being used in the paediatric population because of the rapid recovery and low rates of complications associated with it. There is, however, a risk of symptomatic regrowth with this technique. The objective of our study is to establish the rate of, and risks for, revision surgery over time in a major tertiary referral centre with a large cohort of paediatric Coblation ICT cases. METHODS: A retrospective review of all children (0-19 years) undergoing Coblation ICT from April 2013 to June 2022 was undertaken, using electronic databases and clinical records. Post-operative follow up was reviewed and revision cases were subsequently identified and examined. Statistical analysis was performed using a Chi-Squared test. RESULTS: 4111 patients underwent Coblation ICT during the studied period, with or without concomitant adenoidectomy. Of these, 135 (3.3 %) required revision tonsil surgery, primarily for recurrence of initial symptoms; two patients required two consecutive revision procedures (137 revision procedures in total). Eight-eight (n = 88) (64 %) of these were revised with a repeat Coblation ICT procedure and 49 (36 %) with bipolar diathermy extracapsular tonsillectomy (ECT) of remnant tonsil tissue. The revision rates after Coblation ICT declined steeply on a year-on-year basis since the commencement of this technique (from 10.6 % early on, to 0.3 % at the end of the study period P<0.001). A significantly higher revision rate was noted in children below the age of two at the time of primary surgery, compared to those older than two years of age (P<0.001). CONCLUSIONS: This study demonstrates real-world departmental revision rates over a nine-year period from the technique's commencement of use. With Coblation ICT, symptomatic re-growth occurs rarely, but may be clinically significant, with higher rates of recurrent symptoms seen in children under two years of age at the time of primary surgery. The revision rate apparently drops over time in parallel with overall experience of surgeons and formalised training.

Nasolacrimal tuberculosis: case report highlighting the need for imaging in identifying and managing it effectively.

PURPOSE: To report a rare case of nasolacrimal tuberculosis, conduct a literature review, and to suggest an optimal management plan. METHODS: A 39-year old Zimbabwean female presented with a 3-year history of left epiphora, haemolacria and medial canthal mass. On ophthalmic examination there was no lateral displacement of the left globe. The initial management was external dacryocystorhinostomy. Histology of the biopsy was inconclusive and her symptoms did not improve. This prompted a referral to otolaryngology. Nasal examination revealed a friable mass of the middle turbinate. CT scan showed paranasal sinus and lacrimal sac destruction and lateral displacement of the globe. Endoscopic sinus surgery confirmed the CT findings, allowed a biopsy taken, and the histology showed prominent caseating granulomatous inflammation. Microbiological cultures confirmed nasolacrimal tuberculosis. CONCLUSION: We report a case of primary tuberculosis affecting the nasolacrimal apparatus presenting with a medial canthal mass. This report highlights the need for high index of suspicion, and initial CT imaging in order to avoid invasive procedures such as external dacryocystorhinostomy, which may cause extra surgical morbidity and delay diagnosis and treatment.