Taking the heat out of tonsillectomy

By Sally Robertson, B.Sc.Aug 7 2012

Cooling of the spaces in which the tonsils are lodged (tonsillar fossae) during tonsillectomy, reduces post-operative pain and accelerates healing, report researchers.

"Our report demonstrates that any surgical technique using [a] "hot" device is likely to reduce postoperative pain significantly if it combines irrigation of the tonsillar fossae with isotonic fluid," say Ciǧdem Tepe Karaca (Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey) and colleagues.

Thermal welding (TW) is an innovative tonsillectomy method that significantly reduces blood loss and surgical procedure time. The technique uses heat and pressure to simultaneously coagulate and remove soft tissue, producing a narrow high-temperature (300-400°C) cutting zone surrounded by a lower temperature (60‑100°C) coagulating zone.

However, the surrounding tissue undergoes mechanical or thermal damage that results in severe pain due to inflammation, spasm of the exposed pharyngeal muscles, and nerve irritation, explains the team.

To try and lessen the impact of thermal damage induced by TW tonsillectomy, the researchers used 0.9% isotonic fluid at a temperature of 23°C to irrigate the fossa of one tonsil in each of 30 children (aged 5‑13 years) who underwent the procedure.

The children reported significantly higher pain scores on a visual analogue scale 3, 7, and 14 days after surgery for the tonsillar fossa that was not irrigated than they did for the fossa that was irrigated.

In addition, analysis of the post-tonsillectomy slough (dead tissue cast off from healthy flesh) 7 and 14 days after surgery, showed that the healing process of the cooled tonsillar fossa was significantly better than that of the control fossa. The proportion of slough covering the tonsil bed at postoperative days 7 and 14 was 69.2% and 10.0%, respectively, in the irrigated fossa compared with 85.8% and 30.8%, respectively, in the control fossa.

Writing in the European Archives of Otorhinolaryngology, the authors conclude: "Administration of isotonic fluid, during thermal welding tonsillectomy for cooling tonsillar fossae, accelerates the wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively."

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