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1.
Trials ; 22(1): 617, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526073

RESUMO

BACKGROUND: Tonsillar surgery has been used for decades to treat recurrent and chronic tonsillitis in adults. Recurrent and chronic tonsillitis result in disturbing symptoms, treatment costs, sick leave, and impaired quality of life (QoL). Theoretically, removing all or part of the altered pathological palatal lymphoid tissue alleviates the symptoms and enhances the QoL. Whether this is true with total or partial tonsillar resection (tonsillectomy (TE) and tonsillotomy (TT), respectively) has not been reported in a randomised trial yet. METHODS: We conduct a multicentre, partly blinded, randomised, 6-month, parallel-group clinical study including 285 adult participants referred to surgical treatment for chronic or recurrent tonsillitis. The participants will either have TE, TT or watchful waiting (WW). The primary outcome will be the difference between the mean disease-specific Tonsillectomy Outcome Inventory-14 (QoL questionnaire) scores at 6 months. Comparison is made firstly between the combined TE+TT and WW groups (superiority analysis), and secondly between the TE and TT groups (non-inferiority analysis). DISCUSSION: This study will add significant new information to the effects and harms of TE and TT procedures in the treatment of adults with chronic or recurrent tonsillitis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04657549.


Assuntos
Tonsilectomia , Tonsilite , Adulto , Doença Crônica , Humanos , Estudos Multicêntricos como Assunto , Tonsila Palatina/cirurgia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Tonsilectomia/efeitos adversos , Tonsilite/diagnóstico , Tonsilite/cirurgia
2.
J Laryngol Otol ; 135(9): 844-845, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34376269

RESUMO

BACKGROUND: Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. METHOD: Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. RESULTS: The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. CONCLUSION: This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/instrumentação , Pescoço/cirurgia , Tonsila Palatina/cirurgia , Humanos , Glândulas Paratireoides/cirurgia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/instrumentação , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/instrumentação
3.
Artigo em Chinês | MEDLINE | ID: mdl-34304528

RESUMO

Objective:To investigate the effect of preventive measures in reducing postoperative bleeding, which is made for children day surgery on tonsils and adenoids in our hospital, and to clarify its safety and feasibility. Methods:A retrospective analysis of 649 patients with children day surgery due to obstructive sleep apnea(OSA) caused by adenoid hypertrophy of tonsil was conducted. All of the patients were admitted to Shanghai Children's Hospital from February 2021 to April 2021. According to whether preventive measures were taken or not, they were divided into the control group and the observation group. The postoperative bleeding rate, bleeding time, and bleeding-related factors of the two groups were compared. Results:There were 4 cases(1.22%) in the observation group and 12 cases(3.74%) in the control group, the postoperative bleeding rate of the observation group was lower than that of the control group(χ²=4.28, P=0.039). The postoperative bleeding in the observation group occurred(8.25±2.75) days after surgery while the control group(7.42±1.98) days, which shows no significant difference in postoperative bleeding time between the two groups(χ²=2.601, P=0.321). There was no case of postoperative infection in the observation group while 7 cases(58.3%) in the control group(χ²=7.658, P=0.036). Conclusion:For children with day surgery of tonsils and adenoids, appropriate optimization measures can be taken for hospital admission evaluation, infection prevention, postoperative observation, publicity and education, which can effectively reduce the incidence of postoperative complications and improve the treatment effect of day surgery.


Assuntos
Tonsila Faríngea , Tonsilectomia , Adenoidectomia , Tonsila Faríngea/cirurgia , Procedimentos Cirúrgicos Ambulatórios , Criança , China , Humanos , Hipertrofia , Tonsila Palatina/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos
4.
Artigo em Chinês | MEDLINE | ID: mdl-34304542

RESUMO

Adenoid and tonsil hypertrophy in children are closely related to asthma. Their pathogenesis and clinical symptoms are interacted on each other. The unified airway theory believes that the upper and lower respiratory tracts are connected through the release of systemic inflammatory factors. Studies have shown that adenoid and tonsillectomy surgery have a positive effect on the control and development of asthma. The symptoms of postoperative asthma, frequency of attacks, control medication and asthma severity related indicators in children were significantly reduced compared with those before surgery. It has been shown that asthma can increase the incidence of respiratory complications after adenoidectomy and tonsillectomy, so postoperative care after adenotonsillectomy is also important to control asthma. Understanding the relationship between diseases can help clinicians make a more comprehensive diagnosis and treatment.


Assuntos
Tonsila Faríngea , Asma , Tonsilectomia , Adenoidectomia , Tonsila Faríngea/cirurgia , Criança , Humanos , Hipertrofia , Tonsila Palatina/cirurgia
5.
Acta Otorhinolaryngol Ital ; 41(3): 197-205, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33970896

RESUMO

Objective: Interactions between SARS-CoV-2 and pharyngeal associated lymphoid tissue are thought to influence the manifestations of COVID-19. We aimed to determine whether a previous history of tonsillectomy, as a surrogate indicator of a dysfunctional pharyngeal associated lymphoid tissue, could predict the presentation and course of COVID-19. Methods: Multicentric cross-sectional observational study involving seven hospitals in Northern and Central Italy. Data on the clinical course and signs and symptoms of the infection were collected from 779 adults who tested positive for SARS-CoV-2, and analysed in relation to previous tonsillectomy, together with demographic and anamnestic data. Results: Patients with previous tonsillectomy showed a greater risk of fever, temperature higher than 39°C, chills and malaise. No significant differences in hospital admissions were found. Conclusions: A previous history of tonsillectomy, as a surrogate indicator of immunological dysfunction of the pharyngeal associated lymphoid tissue, could predict a more intense systemic manifestation of COVID-19. These results could provide a simple clinical marker to discriminate suspected carriers and to delineate more precise prognostic models.


Assuntos
COVID-19 , Tonsila Palatina , Tonsilectomia/efeitos adversos , Adulto , Idoso , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Tonsila Palatina/cirurgia , Pandemias , SARS-CoV-2
6.
J Int Med Res ; 49(5): 3000605211011930, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33947259

RESUMO

OBJECTIVE: To investigate the effect and prognosis of subtotal intracapsular tonsillectomy. METHODS: All children (n=162) with tonsillar hypertrophy and chronic tonsillitis were randomly divided into two groups: tonsillectomy (n=75) and subtotal intracapsular tonsillectomy (n=87). Tonsillectomy: the tonsillar tissue was completely removed along with the tonsillar capsule. Subtotal intracapsular tonsillectomy: 80% to 90% of the tonsils and the complete epithelium of the tonsillar crypts were removed without damaging the tonsillar capsule. The Face, Legs, Activity, Cry, and Consolability (FLACC) and parents' postoperative pain measure (PPPM) scales were used to evaluate postoperative pain, and the obstructive sleep apnea (OSA)-18 questionnaire was used to assess the children's postoperative quality of life. The patients were followed-up for 2 years. RESULTS: 1. The FLACC and PPPM scales indicated that the children's postoperative pain after subtotal intracapsular tonsillectomy was significantly less than that of children undergoing tonsillectomy. 2. The OSA-18 scale scores indicated that subtotal intracapsular tonsillectomy significantly improved the children's quality of life. 3. Two years after subtotal intracapsular tonsillectomy, no patients required reoperation. CONCLUSION: Subtotal intracapsular tonsillectomy may be the first choice for tonsillar hypertrophy and chronic tonsillitis patients.


Assuntos
Apneia Obstrutiva do Sono , Tonsilectomia , Tonsilite , Criança , Humanos , Dor Pós-Operatória , Tonsila Palatina/cirurgia , Qualidade de Vida , Apneia Obstrutiva do Sono/cirurgia , Tonsilite/cirurgia
7.
Head Neck ; 43(7): 2185-2192, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33780072

RESUMO

BACKGROUND: Margins in transoral surgery for tonsil cancer can be limited by oropharyngeal wall thickness (OWT), but the normal range is not well established. METHODS: In 240 noncancer subjects, OWT was measured bilaterally in the vicinity of the tonsils with MRI. Statistical analysis was performed to assess for interaction of age, sex, location, and obesity. RESULTS: Mean(SD) OWT measured 3.4(0.6) mm posteriorly, 3.7(2.0) mm between the styloglossus and stylopharyngeus, and 5.3(0.8) mm laterally. OWT was greater in men, correlated with obesity, decreased posteriorly and laterally in the 60-80 versus 40-59 year age groups, and increased when styloglossus/stylopharyngeus were closer. OWT was <5 mm in 36.7%-97.9% of locations, with the largest percentage below this threshold located posteriorly. CONCLUSIONS: OWT is frequently <5 mm, particularly in the posterior and intermuscular areas, suggesting that a smaller surgical margin may need to be accepted in transoral tonsil cancer surgery for anatomic reasons.


Assuntos
Neoplasias Orofaríngeas , Procedimentos Cirúrgicos Robóticos , Neoplasias Tonsilares , Humanos , Masculino , Margens de Excisão , Neoplasias Orofaríngeas/cirurgia , Tonsila Palatina/diagnóstico por imagem , Tonsila Palatina/cirurgia , Língua , Neoplasias Tonsilares/diagnóstico por imagem , Neoplasias Tonsilares/cirurgia
8.
Int J Pediatr Otorhinolaryngol ; 144: 110674, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33725589

RESUMO

INTRODUCTION: Tonsillar microenvironment is thought to contribute to innate immune dysregulation responsible for the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) because of beneficial effects of tonsillectomy on treatment of the syndrome. Accordingly previous studies reported altered lymphocyte frequency, cytokine level and microbial composition in PFAPA tonsils. The aim of our study is to monitor expression levels of pro-inflammatory cell surface Toll-like receptors (TLRs) which have important role in induction of inflammation and maintaining tissue haemostasis. MATERIALS AND METHODS: Seven patients with PFAPA syndrome, and eight patients with group A beta-hemolytic streptococcal (GAßHS) recurrent tonsillitis were included in our study. Tonsillar expression levels of TLR-1, -2, -4, -5, and -6 were monitored by immunohistochemistry (IHC). Expression levels were scored using semi-quantitative analysis method and were statistically analyzed by Two-Way Repeated Measures Analysis of Variance test. RESULTS: IHC analysis demonstrated expression of all TLRs in tonsillar surface epithelium (SE) and lymphoid interior (LI) except for TLR-6 which was not present in the former. There has not been any statistically significant difference in TLR expression levels between PFAPA and GAßHS tonsils, except for TLR-1 and TLR-2 which were higher on LI and lower on SE of PFAPA tonsils, respectively, than that of the GAßHS samples. CONCLUSIONS: Altered TLR expression levels may be involved in PFAPA pathogenesis. Future studies with higher patient number, uninflamed tonsils and cellular markers are required to further enlighten the role of TLRs in the development of syndrome.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Receptor 1 Toll-Like/metabolismo , Receptor 2 Toll-Like/metabolismo , Tonsilite , Humanos , Tonsila Palatina/cirurgia , Tonsilite/cirurgia
11.
Tidsskr Nor Laegeforen ; 141(5)2021 03 23.
Artigo em Norueguês | MEDLINE | ID: mdl-33754678

RESUMO

BACKGROUND: Tonsillectomy and tonsillotomy are common surgical procedures, especially among children and adolescents. Post-operative bleeding is a potentially alarming and dangerous complication. We wished to identify the prevalence of postoperative bleeding and associated risk factors in Ålesund hospital. MATERIAL AND METHOD: The study is based on a retrospective review of the records of all patients who underwent tonsil surgery at Ålesund hospital in the five-year period from 2015-2019. RESULTS: Of 1394 patients who underwent tonsil surgery, tonsillectomy was performed in 1285 patients and tonsillotomy in 109 patients. Thirty patients (2.2 %) had primary haemorrhage (< 24 hours). Twenty patients (1.4 %) were hospitalised due to secondary haemorrhage (> 24 hours), after an average of 5.4 days. Five patients (0.4 %) were reoperated due to postoperative bleeding. No postoperative bleeding was recorded after tonsillotomy. Increased risk of late postoperative bleeding was found for patients aged 16 years and over, and patients with primary haemorrhage. INTERPRETATION: The proportion of cases of postoperative bleeding was low compared to international studies. Our figures are likely representative for other otorhinolaryngology departments in Norway, and may provide useful information to clinicians and patients prior to tonsil surgery.


Assuntos
Tonsila Palatina , Tonsilectomia , Adolescente , Criança , Humanos , Noruega , Tonsila Palatina/cirurgia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Tonsilectomia/efeitos adversos
12.
Laryngoscope ; 131(7): E2149-E2152, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33630321

RESUMO

OBJECTIVES/HYPOTHESIS: Tonsillectomy is an effective treatment for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, but the role of adenoidectomy, as well as later tonsillar regrowth, is unclear. To find out if the volume of lymphoid tissue is pivotal to the efficacy, we analyzed the association between the relapse of the symptoms of PFAPA syndrome and regrowth of tonsillar tissue after tonsillectomy or adenotonsillectomy. STUDY DESIGN: Prospective cohort study of operated PFAPA pateints. METHODS: We invited all patients that had undergone tonsillectomy or adenotonsillectomy due to PFAPA syndrome at the Oulu University Hospital, Oulu, Finland, between the years 1990 and 2007, at the age of ≤12 years, to a follow-up visit, after an average period of 9.8 years after their diagnoses. Out of the 132 invited, 94 (71%) participated in the follow-up study. RESULTS: At the follow-up study visit, 5 (5%) of the 94 PFAPA syndrome cases experienced recurrent fevers. The regrowth of palatine tonsillar tissue was seen in four of them (80%) as compared to 19/89 (21%) of symptom-free patients (P = .006). Two of the patients with clear PFAPA relapse at the time of the study visit were reoperated with clear effect on the symptoms. At the time of the study visit, 59/63 (94%) of the patients who had undergone adenotonsillectomy and 30/31 of the patients (97%) who had undergone tonsillectomy earlier were free of fever flares (P = .99). CONCLUSION: Palatine tonsil regrowth was associated with PFAPA syndrome relapse after tonsillectomy. Reoperation might be a treatment option in these patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2149-E2152, 2021.


Assuntos
Doenças Hereditárias Autoinflamatórias/cirurgia , Linfadenite/cirurgia , Faringite/cirurgia , Estomatite Aftosa/cirurgia , Tonsilectomia/efeitos adversos , Adenoidectomia/efeitos adversos , Criança , Feminino , Finlândia/epidemiologia , Seguimentos , Doenças Hereditárias Autoinflamatórias/patologia , Humanos , Linfadenite/patologia , Masculino , Pescoço/patologia , Tonsila Palatina/crescimento & desenvolvimento , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Faringite/patologia , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Estomatite Aftosa/patologia , Síndrome , Resultado do Tratamento
13.
Am J Otolaryngol ; 42(3): 102979, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33612272

RESUMO

BACKGROUND: The aim of this study was to describe the potential advantages of the 3D endoscope-assisted anterior tonsillar fossa approach to elongated styloid process. METHODS: A 58 years-old woman was reported to our Department with one-year history of odynophagia, latero-cervical pain on the left side, and ipsilateral foreign body sensation. Pain was dull and intermittent in nature. The patient had visited different clinics, she had a physiatric and maxillo-facial evaluation with two dental extraction without any relief of the symptoms. On physical examination a hard-bony consistency area was palpated over left-sided tonsillar fossa, evocating severe pain. Three-dimensional computed tomography (CT) confirmed an anomalous length of the left styloid process and a diagnosis of Eagle's syndrome (ES) was made. After careful surgical and anesthesiology evaluation, we decided to proceed with the partial excision of the styloid process with a 3d endoscope-assisted transoral anterior tonsillar fossa approach (Reddy et al., 2020). RESULTS: The patient was relieved of her symptoms after the surgery and was discharged after 1 day. Postsurgical healing was uneventful, pharyngodynia was observed for the first 48 h and treated with anti-inflammatory medication. No early or late postoperative complications, including massive bleeding, neurovascular injury or infection, were encountered. At 1 year follow up visit the patient was still asymptomatic and the CT scan did not show any abnormalities. The 3D endoscope provided a high-quality magnification of the tonsillar fossa, which allow us to correctly identify the site of incision. Styloid process was identified through digital palpation. After sufficient dissection of the tip, the distal part of the elongated styloid process was osteotomised and retrieved with a curved instrument. Local hemostasis was achieved and wound was closed in layers. CONCLUSION: Some authors suggested novel surgical approach for ES like transoral robotic surgery (Rizzo-Riera et al., 2020 [2]). We present the 3D endoscope-assisted anterior tonsillar fossa approach as a feasible alternative for the surgical management of ES. Our experience with this approach has been outstanding, guaranteeing an optimal vision and depth of the surgical field with safe manipulation of the instruments which avoided injuries to healthy tissue. Furthermore, 3d endoscope was a great didactic tool. In our opinion is not necessary to remove all the styloid process, as other authors suggest (Lisan et al., 2019 [3]), but is sufficient a partial styloidectomy after cutting the stylohyoid ligament.


Assuntos
Imageamento Tridimensional , Cirurgia Endoscópica por Orifício Natural/métodos , Ossificação Heterotópica/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Tonsila Palatina/cirurgia , Cirurgia Assistida por Computador/métodos , Osso Temporal/anormalidades , Osso Temporal/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/patologia , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547127

RESUMO

Two patients suffering from chronic recurrent tonsillitis were reported. The first patient was confirmed infected with COVID-19, 3 weeks prior to tonsillectomy. The detritus and tonsil specimen were further analysed through real-time PCR (RT-PCR) and revealed amplification of the fragment N and ORF1ab genes of SARS-CoV-2. The second patient had a negative IgM and positive IgG antibody for COVID-19; however, the nasopharyngeal swab indicated negative for SARS-CoV-2. Tonsillectomy was performed 2 weeks after the swab; the tonsil specimen was analysed through RT-PCR and revealed amplification of the N2 and RdRp gene of SARS-CoV-2. According to both results, the presence of the SARS-CoV-2 gene remains to be detected in tonsil and/or detritus after 2-3 weeks after recovery. Hence, it is suggested that it is necessary to use adequate protection when performing tonsillectomy on early recovered patients with COVID-19. Furthermore, tonsillectomy would be more advisable to be performed after the fourth week after recovery from COVID-19.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/complicações , COVID-19/diagnóstico , Tonsila Palatina/virologia , Tonsilite/complicações , Adulto , Feminino , Humanos , Masculino , Tonsila Palatina/cirurgia , SARS-CoV-2 , Tonsilectomia/métodos , Tonsilite/cirurgia , Adulto Jovem
15.
Laryngorhinootologie ; 100(7): 556-561, 2021 07.
Artigo em Alemão | MEDLINE | ID: mdl-33461227

RESUMO

BACKGROUND: In 2017, the Federal Joint Committee determined tonsillectomy and hysterectomy in non-oncologic diseases as well as tonsillotomy for second opinion procedure. We discuss the suitability of tonsillectomy and tonsillotomy for the second opinion procedure on its quantitative and qualitative characteristics. MATERIALS AND METHODS: Data from the Federal Statistical Office concerning numbers of cases were evaluated. Numbers and regional distribution of ENT-specialists providing second opinion were analyzed by websites of Associations of SHI Physicians. RESULTS: Between 2005 and 2018a significant decrease in tonsillectomy cases from 119 808 to 42 548 is observable that is by far not compensated by increasing tonsillotomy numbers from 4659 (2007) to 18 369. At the same time, surgical procedure rates at regional levels remain volatile. 218 ENT-specialists in 142 towns provide second opinion. On basic of case numbers in 2018a relationship of 1(ENT-specialist): 280 (tonsillectomy/tonsillotomy patients) results (range from 1:90 to 1:800). CONCLUSIONS: On the background of decreasing surgical rates tonsil surgery does not comply with the requirements of second opinion procedure. Reachability of second opinion providers is difficult in many regions, such compromising a compensation of different levels of surgery. As a result of our investigation we recommend scientific supervision of currently second opinion procedures and a survey of actual demand from the patient's viewpoint.


Assuntos
Tonsila Faríngea , Tonsilectomia , Feminino , Humanos , Tonsila Palatina/cirurgia , Encaminhamento e Consulta , Inquéritos e Questionários
16.
J Laryngol Otol ; 135(2): 179-181, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33500010

RESUMO

BACKGROUND: Simulation training has become a core component in the training of ENT surgeons. It provides the opportunity for the repetitive practice of a surgical technique. Simulators are broadly categorised into low- and high-fidelity simulators. A method using a home microprocessor to enhance a low-fidelity surgical simulator is introduced. METHOD: The Yorick tonsil tie trainer was enhanced using an Arduino microcontroller attached to the simulated inferior pole of the tonsil. The Arduino was coded to give a visual stimulus when linear motion exceeded parameters. The prototype simulator was tested to gain information on whether the enhancement could identify differences between novice and expert users. CONCLUSION: An enhanced low-fidelity tonsil trainer was produced using a low-cost, simple home microprocessing board. The enhanced simulator gives objective feedback allowing for self-directed learning. Further research is required to evaluate the benefits of these enhancements above non-enhanced simulation training.


Assuntos
Otorrinolaringologistas/educação , Tonsila Palatina/cirurgia , Treinamento por Simulação/métodos , Melhoramento Biomédico/métodos , Competência Clínica/normas , Simulação por Computador , Retroalimentação , Humanos , Treinamento por Simulação/economia , Treinamento por Simulação/estatística & dados numéricos , Cirurgiões/educação
17.
Ann Otol Rhinol Laryngol ; 130(4): 356-362, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32840127

RESUMO

OBJECTIVE: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. STUDY DESIGN: Retrospective chart review and systematic review of the literature. SETTING: Tertiary care academic hospital and multi-hospital private healthcare system. SUBJECTS AND METHODS: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. RESULTS: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. CONCLUSION: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. LEVEL OF EVIDENCE: Pooled analysis of case series from the literature and a single institution, level 4.


Assuntos
Biópsia/métodos , Neoplasias Primárias Desconhecidas , Tonsila Palatina , Neoplasias Tonsilares , Tonsilectomia , Adulto , Humanos , Incidência , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/epidemiologia , Neoplasias Primárias Desconhecidas/patologia , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/epidemiologia , Neoplasias Tonsilares/patologia , Tonsilectomia/métodos , Tonsilectomia/estatística & dados numéricos , Tonsilite/cirurgia , Procedimentos Desnecessários/métodos
18.
Eur Arch Otorhinolaryngol ; 278(1): 265-270, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32767166

RESUMO

PURPOSE: Sleep-disordered breathing, SDB, in children is associated with morbidity that can result in caregivers having to stay at home from work. The aim of this study was to investigate whether the number of days when caregivers are reimbursed, temporary parental benefit (TPB) to stay at home from work to care for their sick child is increased among children with SDB before and after tonsil surgery. METHODS: This is a retrospective, cross-sectional study of children (n = 440), aged 2-11 years, that underwent tonsil surgery for SDB in day surgery at Sahlgrenska University Hospital in 2014 and 2015. TPB, was provided by the Swedish Social Insurance Agency. The expected days of TPB in the general population of the region were calculated. The number of days with TPB was compared 2 years before and 2 years after surgery and compared with the expected days of TPB. RESULTS: Two years before surgery, the children had no more days of TPB than expected. Two years after surgery, the children with SDB had 4.8 more days with TPB (p < 0.001) than expected, but, when the 1st month after surgery was excluded from the analysis, there was no difference in days of TPB compared with the general population. CONCLUSION: Children with SDB who had tonsil surgery had no more days of parental benefits 2 years before and 2 years after surgery than expected. SDB is associated with increased morbidity, but it does not appear to cause caregivers to stay at home in the majority of children.


Assuntos
Síndromes da Apneia do Sono , Tonsilectomia , Adenoidectomia , Cuidadores , Criança , Pré-Escolar , Estudos Transversais , Humanos , Tonsila Palatina/cirurgia , Estudos Retrospectivos , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/cirurgia , Suécia
19.
Pediatr Hematol Oncol ; 38(1): 25-35, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32804010

RESUMO

INTRODUCTION: Children with low von Willebrand factor (VWF) activity or type 1 von Willebrand disease (VWD) have increased risk of bleeding after adenotonsillar procedures and the optimal perioperative management to minimize bleeding is unknown. AIM: To report the effectiveness and safety of an institutional protocol in minimizing postoperative bleeding in children with type 1 VWD or low VWF activity. METHODS: We conducted a retrospective chart review in children with type 1 VWD or low VWF activity treated via an institutional protocol that utilizes repeated doses of Desmopressin acetate (DDAVP, 1-deamino 8-D arginine- vasopressin) or VWF concentrate, brief hospitalization for observation and extended use of oral epsilon aminocaproic acid (EACA). RESULTS: From 2010 to 2017, 13 children underwent an adenotonsillar procedure and were treated with this protocol. Although 7.6% had minor immediate bleeding and 23% had minor delayed bleeding, no patients experienced major bleeding or required transfusion, additional surgery or other measures not specified by the protocol. Mild hyponatremia was observed in 80% of patients who received DDAVP. CONCLUSION: Our institutional protocol specifying repeated dosing of DDAVP or VWF concentrate to sustain elevated VWF levels during periods of highest bleeding risk and extended use of EACA is effective at preventing major bleeding episodes after adenotonsillar procedures. However, this analysis raised safety concerns that prompted changes in the institutional protocol and highlight the need for further prospective studies to determine the optimal strategy for safely reducing bleeding complications in these patients.


Assuntos
Tonsila Faríngea/cirurgia , Hemostasia/genética , Tonsila Palatina/cirurgia , Fator de von Willebrand/genética , Feminino , Humanos , Masculino , Estudos Retrospectivos
20.
Laryngoscope ; 131(5): 1157-1162, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32975857

RESUMO

OBJECTIVES/HYPOTHESIS: To evaluate the application and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric patients with tonsillar hypertrophy and recurrent tonsillitis. STUDY DESIGN: Retrospective chart review. METHODS: A total of 726 children who were diagnosed with either tonsillar hypertrophy or recurrent tonsillitis were included. Children were divided into two groups according to the surgical technique: conventional coblation tonsillectomy and coblation tonsillectomy with inferior pole capsule preservation. The duration of surgery, intraoperative hemorrhage volume, and postoperative pain, as well as postoperative hemorrhage data in the format of time, location, and degree were compared between the two groups. RESULTS: Of the 726 children included, conventional coblation tonsillectomy was performed in 320 children, coblation tonsillectomy with inferior pole capsule preservation was performed in 406 children. There were no significant differences in duration of surgery or intraoperative hemorrhage volume between the two groups. Children who underwent coblation tonsillectomy with inferior pole capsule preservation showed a remarkable improvement in postoperative pain on days 3 and 5 postoperatively. Additionally, the coblation tonsillectomy with inferior pole capsule preservation group exhibited a significantly lower total postoperative hemorrhage rate, secondary hemorrhage rate, and hemorrhage rate in the inferior pole compared with that in the conventional coblation tonsillectomy group. During the 1-year follow-up period, no cases of tonsillar re-hypertrophy or recurrent tonsillitis were observed in either group. CONCLUSION: For pediatric tonsillar hypertrophy and recurrent tonsillitis, coblation tonsillectomy with inferior pole capsule preservation is a safe and effective technique, capable of reducing postoperative pain and hemorrhage, especially secondary hemorrhage at the inferior pole. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:1157-1162, 2021.


Assuntos
Dor Pós-Operatória/diagnóstico , Tonsila Palatina/patologia , Hemorragia Pós-Operatória/epidemiologia , Tonsilectomia/métodos , Tonsilite/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipertrofia/cirurgia , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Tonsila Palatina/cirurgia , Hemorragia Pós-Operatória/etiologia , Recidiva , Estudos Retrospectivos , Tonsilectomia/efeitos adversos , Resultado do Tratamento
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