Tonsil

Intraoperative bupivacaine for reduction of post-tonsillectomy pain: A randomized, placebo-controlled, double-blind study of 26 patients

August 31, 2009     Tammara L. Watts, MD, PhD and Stilianos E. Kountakis, MD, PhD
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Abstract

We conducted a randomized, controlled, double-blind, prospective study to evaluate the effect of intraoperative bupivacaine injection on postoperative pain control following Bovie cautery-assisted tonsillectomy in 26 adults. Sixteen patients were injected with 10 ml of 0.5% bupivacaine with 1:200,000 epinephrine, and 10 were injected with 10 ml of normal saline solution. For 10 days after surgery, patients completed a questionnaire to rate their overall pain and to record their narcotic consumption and oral intake. At study's end, there was no statistically significant difference in pain scores, narcotic use, and oral intake between the bupivacaine group and the controls (p = 0.13, 0.37, and 0.35, respectively). We conclude that the effects of perioperative bupivacaine on postoperative pain control in tonsillectomy patients are similar to those of placebo.

Lymphoma in the Waldeyer ring: A great masquerader

May 31, 2009     Ryan F. Osborne, MD, FACS, Jason S. Hamilton, MD, FACS, and Sofia Avitiaz, MD
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Avoiding oral burns during electrocautery tonsillectomy

February 1, 2009     Thomas R. Lowry, MD, FACS and Jonathon R. Workman, MD, FACS
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Abstract

Electrocautery tonsillectomy is a common method of tonsil removal, and electrocautery devices are widely available. Although these devices are relatively safe, inadvertent patient injury may occur with their use, such as oral cavity burns. We describe a simple surgical technique that reduces the risk of oral burns during electrocautery tonsillectomy and review additional safety considerations.

Intratonsillar abscess: A rare cause for a common clinical presentation

December 1, 2008     Eng Cern Gan, MBBS, MRCS, Yuk Hui Ng, MBBS, MRCS, Siew Yoong Hwang, MBBS, FRCS, and Peter Kuo San Lu, MBBS, FRCS
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Abstract

Intratonsillar abscess is a rare clinical condition in patients who present with odynophagia. We report the case of a 33-year-old man who presented with odynophagia, unilateral tonsillar enlargement with palatal fullness, and deviation of the uvula. Failed attempts at drainage of a presumptive peritonsillar abscess and a worsening of signs and symptoms led to a clinical suspicion of a parapharyngeal abscess. Computed tomography of the neck detected a 2.6 x 2.3-cm intratonsillar abscess. The abscess was drained, and the patient's signs and symptoms resolved. Our review of the current English-language literature revealed that only 8 such cases have been previously reported. We report this new case to increase awareness of this condition, to demonstrate the diagnostic difficulty in such cases, and to discuss the pathophysiology of intratonsillar abscess formation.

Harmonic scalpel tonsillectomy versus monopolar diathermy tonsillectomy: A prospective study

May 31, 2008     Jason A. Roth, BSc(Med), MBBS, Tobias Pincock, MBBS, FRACS;, Raymond Sacks, MBBCh, FCS(SA)ORL, Martin Forer, MBBCh, FRACS;, Neil Boustred, MBBCh, FCS(SA)ORL, William Johnston, MBBS, FRACS;, and Michael Bailey, PhD, MSc
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Abstract

For tonsillectomy, the ultrasonic harmonic scalpel has been purported to cause less tissue injury and postoperative morbidity while providing adequate levels of hemostasis. We undertook a prospective study to compare outcomes in 162 patients who had undergone harmonic scalpel tonsillectomy and 40 patients who had undergone monopolar diathermy tonsillectomy over a 33-month period. We found that patients in the harmonic scalpel group experienced significantly less intraoperative bleeding (5.0 vs. 16.5 ml; p < 0.0001). There was no clinically significant difference between the groups with respect to (1) the amount of operating time, (2) the incidence of postoperative nausea and vomiting, dysphonia, and primary or secondary bleeding, and (3) the amount of time patients needed to resume normal diet and activities.

Safety and efficacy of pressure-assisted tissue-welding tonsillectomy: A preliminary evaluation

February 1, 2008     Randall G. Michel, MD, FACS, Bernard I. Weinstock, MD, and Kang Tsau, MD
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Abstract

We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.

Solitary neurofibroma of the palatine tonsil: A case report

December 1, 2007     Kumar Madhumita, MS(ENT), Ajit Nambiar, MD(Path), and Parameswaran Prathapan, MS(ENT)
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Abstract

We present a rare case of a benign tumor of the tonsil in a 49-year-old woman. The tumor was excised in its entirety, and the patient's postoperative course was uneventful. No evidence of recurrence was detected during follow-up. Although some sporadic cases of tonsillar schwannoma have been reported, to the best of our knowledge this is only the second case of a solitary neurofibroma of the palatine tonsil to be reported in the English-language literature.

Unilateral tonsillar lymphoepithelioma with ipsilateral parapharyngeal space involvement: A case report

December 1, 2007     Scott L. Lee, MD, Ching Y. Lee, MD, PhD, Rami K. Batniji, MD, and Steven Silver, MD
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Abstract

We report a case of unilateral tonsillar lymphoepithelioma with extension into the ipsilateral parapharyngeal space, and we review the clinical, histologic, and radiographic findings of the case. The patient presented with a tonsillar mass that was confirmed on biopsy to be lymphoepithelioma. Computed tomography demonstrated ipsilateral parapharyngeal space involvement. Association with Epstein-Barr virus was not assessed since it does not affect the treatment modality. We also review the literature and discuss the diagnosis and current treatment options.

Comparison of Helicobacter pylori colonization on the tonsillar surface versus tonsillar core tissue as determined by the CLO test

July 31, 2007    
article

Bijan Khademi, MD;
Nika Niknejad, MD;
Behrooz Gandomi, MD;
Firoozeh Yeganeh, MD

Abstract
We conducted a prospective study to determine the correlation between the presence or absence of Helicobacter pylori on the tonsillar surface and in the tonsillar core as determined by the Campylobacter-like organism (CLO) rapid urease enzyme test. Our study population was made up of 55 patients who underwent adenoidectomy, tonsillectomy, or both from December 2002 through April 2003 at Khalili Hospital in Shiraz, Iran. Of these 55 patients, 45 (82%) were positive and 10 (18%) were negative for H pylori colonization as determined by CLO testing. Analysis of samples obtained from individual patients revealed differences in H pylori colonization between tonsillar surface samples and the core tissue samples. Of 106 tonsils obtained from 53 patients who underwent adenotonsillectomy or tonsillectomy, H pylori was found on 56 tonsillar surface samples (53%) and 24 tonsillar core samples (23%); only 13 tonsils (12%) contained H pylori both on the surface and in the core. We conclude that a surface swab is neither specific nor sensitive as an indicator of the presence or absence of H pylori colonization in tonsillar core tissue.

Schwannoma of the tonsil

May 31, 2007     Byung-Joo Lee, MD, PhD; Soo-Geun Wang, MD, PhD; Jin-Choon Lee, MD, PhD; Il-Woo Lee, MD, PhD
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Abstract

Between 25 and 48% of schwannomas have been reported to occur in the head and neck region; the acoustic nerve is involved in most cases. Schwannomas arising in the tonsil are extremely uncommon. We report a case of tonsillar schwannoma in a 23-year-old woman. We also review the literature on this rare entity.

Follicular dendritic cell sarcoma of the tonsil: A case report and literature review

March 31, 2007     Chad McDuffie, MD; Timothy S. Lian, MD; Joel Thibodeaux, MD
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Bilateral peritonsillar abscesses: A challenging diagnosis

March 1, 2007     James T. Edinger, MD; Elias Y. Hilal, MD; Khurshed J. Dastur, MD
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