Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns

Berk Gurpinar*, Ziya Salturk, Meltem E. Akpinar, Ozgur Yigit and Artunc Kaan Turanoglu

Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns.

Tonsillectomy continues to be one of the most common surgical procedures in otolaryngology
for years. Although, not a routine procedure in adults, it is a frequently performed surgical
procedure in the pediatric population. The most common symptoms associated with both adult
and pediatric tonsillectomies include recurrent tonsillitis and obstructive sleep apnea.
Recurrent tonsillitis more commonly affects the patient population associated with schools,
daycares or military services. Therefore, schoolgoing children or adults living in large communities are generally the most affected group of patients.

Adult tonsillectomy may cause substantial post-operative pain and morbidity and is often associated with greater blood loss than pediatric
tonsillectomy. Developing a condition of increased fibrosis from previous
infections, combined with large blood vessels, is
thought to be a possible cause of greater blood loss in adult tonsillectomy.

To control bleeding intra-operatively, more cauterization is generally required and this substantially increases the post-operative pain on account of thermal injury to the tissue.

Traditional tonsillectomy techniques include cold knife tonsillectomy and electrocautery. Advances
in technology introduced cryosurgery, harmonic scalpel, coblation, PlasmaKnife, microdebrider, sutter and thermal welding to the surgical practices in otolaryngology.

Most of the above techniques demand the use of radio frequency, causing tissue ablation and coagulation at relatively low temperatures thus avoiding thermal injury when compared to electrocautery. CBL ablates the target tissue by generating a field of ionized sodium molecules. The device uses bipolar radiofrequency energy to ablate and coagulate the soft tissue without causing thermal injury.

During coblation, conductive saline solution is converted in the gap between the device tip and the tissue into an ionized plasma layer. Plasmacision ablates the tissues by generating a
highly ionized plasma around the active electrode.

Otolaryngol Open J. 2017; 3(3): 47-53. doi: 10.17140/OTLOJ-3-142