Lille, France – Although advances in children’s surgery have improved postoperative morbidity, the indications for tonsillectomy have changed little. The Congress of Pediatric Societiesheld in Lille from 1 to 3 June 2022, dedicated a session to updating the recommendations by the French Society of Oto-Rhino-Laryngology (SFORL) and Cervico-Facial Surgery (CCF).
Hypertrophy and sleep disorders
If the indications of infectious origin are well marked (> 7 episodes of infection over the last year, or> 5 / year over the last 2 years, or> 3 / year over the last 3 years), hypertrophy and sleep are the other part of the indications: the presence of nocturnal and / or diurnal signs evoking a respiratory disturbance of sleep must be sought, and the interrogation of the parents on this subject has an excellent predictive value. It is necessary to look for tonsillar hypertrophy leading to upper airway obstruction (VAS) and developing high VAS resistance syndrome or obstructive sleep apnea syndrome (SAHOS), knowing that these two disorders can also exist in the absence of hypertrophy (and vice versa). Nasofibroscopy is particularly useful in assessing nasal obstruction and the extent of hypertrophy in the cavity. Polysomnography, on the other hand, is not essential for the assessment of SAHOS except in special cases (discrepancy between clinic and pharyngeal examination, operative risk, morbid obesity, comorbidities…). Finally, there are also a number of situations in which tonsillectomy is not recommended (non-evolutionary unilateral hypertrophy) or recommended on a case-by-case basis.
Partial excision: less painful
Several surgical approaches are considered to perform tonsillectomy: however, most of the techniques used so far have been based on extracapsular dissections. Gradually, these total tonsillectomies have been replaced by partial excisions that are less painful and have a lower risk of bleeding. Thus, intracapsular techniques such as microdebriders, radiofrequency apparatus, or coblation provide the means to gradually remove tissue and thereby allow for reduced postoperative morbidity and an accelerated return to normal activity.
Outpatient tonsillectomy is possible as long as there are no medical contraindications (anesthetic, surgical,…), social criteria are met, and the organization of the structure allows this support. Postoperative monitoring should ensure recovery from food, monitoring for bleeding, vomiting, or postoperative pain, and treatment if necessary.
Despite the success of treatment for obstructive disorders, some children will not be improved: it is necessary to take stock again, consider a polysomnography and perform an induced sleep-induced endoscopy to look for something that would last. For others, there is a risk of recurrence of the disorder in the medium to long term, including adenoid or tonsillar regrowth. Regular monitoring over the following years is therefore recommended.
This article was originally intended published on Univadis.fra member of the Medscape Network.
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