Tonsillectomy in Children: Explanation in the Text Would Have Been Desirable

by Prof. Dr. med. Boris A. Stuck, Dr. med Jochen P. Windfuhr, Dr. med Harald Genzwürker, Prof. Dr. med Horst Schroten, Dr. med Tobias Tenenbaum, Prof. Dr. med. Karl Götte in volume 49/2008

The authors do not distinguish sufficiently precisely between the terms, and indications for, tonsillectomy and tonsillotomy. Basically, tonsillectomy can be subdivided into the traditional extracapsular from and the intracapsular form (tonsillotomy, partial tonsillar resection). In tonsillotomy, the tonsils are incompletely resected. The difference is explained only later in the text.

The authors say that an indication for tonsillectomy or tonsillotomy exists among others in selected types of inflammation of the tonsils or the peritonsillar area. The indication for tonsillotomy, however, is only symptomatic, not inflammatory, obstructive hyperplasia of the tonsils in childhood without any signs of recurring tonsillitis. Tonsillotomy was long seen as an obsolete intervention because after the operation, increased scarring of the remaining tonsillar tissue would develop, with subsequent chronic inflammation or abscesses. These complications were not due so much to the method as to the incorrect indication.

A substantial perceived advantage of tonsillotomy compared with tonsillectomy is the low postoperative risk of hemorrhage. Also, pain is reduced because the palatine arches are spared. These advantages result in a shorter hospitalization period for children. In box 2, the authors list complications after tonsillectomy., but they do not rate these. The text only says that, compared with postoperative hemorrhage, other postoperative complications are rare and therefore not as important. However, some extremely rare and unusual complications were listed (emphysema, pneumomediastinum or thorax, damage to the recurrent laryngeal nerve, meningitis), which in the literature are reported only in case studies. A more detailed explanation in the text would have been desirable. DOI: 10.3238/arztebl.2009.0192a


Dr. med. Michael Reiß
Heinrich-Zille-Str. 13, 01445 Radebeul, Germany
[e-mail]

References

1. Ericsson E, Hultcrantz E: Tonsil surgery in youths: good results with a less invasive method. Laryngoscope 2007; 117: 654–61.

2. Gronau S, Fischer Y: Die Tonsillotomie. Laryngorhinootologie 2005; 84: 685–90.

3. Scherer H: Tonsillotomie versus Tonsillektomie. Laryngorhinootologie 2003; 82: 754–5.

4. Stuck BA, Windfuhr JP, Genzwürker H et al.: Tonsillectomy in children [Die Tonsillektomie im Kindesalter]. Dtsch Arztebl Int 2008; 105(49): 852–61