Is the KTP laser effective in tonsillectomy?

Thirty-eight patients underwent a randomized double-blind trial using the KTP laser for tonsillectomy on one tonsil and standard dissection tonsillectomy on the other tonsil. Blood loss was less on the laser side. However, pain though initially slightly less on the laser side (days 1 and 2 post-operation) was worse on the laser side at 2 weeks due to delayed healing of the tonsillar bed. There were no primary or reactionary haemorrhages but a 15% incidence of secondary haemorrhage on the laser side.     

Carbon dioxide laser surgery of the tongue base

Surgery for benign lesions at the tongue base has, to date, been limited, and little attention has been paid to lingual tonsillitis and lingual tonsil hypertrophy. One of the reasons for this has been an unsatisfactory surgical technique with a significant morbidity.Fifteen patients treated with the carbon dioxide laser for lesions at the tongue base are presented in this paper to show that this surgical technique offers advantages to both the surgeon and the patients.     

Post-tonsillectomy pain with diathermy and ligation techniques. A prospective randomized study in children and adults

150 patients (80 children and 70 adults) were entered into a prospective randomized study to compare the post-tonsillectomy pain of unipolar diathermy as opposed to ligation for haemostasis. In children, we found no difference in post-operative pain between the diathermy and ligation techniques. However, in adults there was a significant difference, more post-operative pain occurring with diathermy. There was no significant difference in the incidence of secondary haemorrhage.     

The effect of tonsillectomy on eustachian tube function

A two-part study was designed to investigate the effect of tonsillectomy on eustachian tube function and to identify if any change is related to postoperative pain. Middle ear pressure was measured by tympanometry and results were classified as type A (+50 daPa to ?99 daPa), type B (flat) or type C (?100 daPa to ?350 daPa). Thirty-one patients with type A tympanograms, undergoing tonsillectomy enrolled in study A. Patients had tympanometry the next day and filled in a questionnaire incorporating visual analogue pain scores. In study B, 30 patients underwent a similar protocol and were followed up at 1 week with tympanometry and a questionnaire. A control group of 26 patients undergoing appendicectomy was recruited. Follow-up was available on 23 patients from study B. Combining A and B, on the first postoperative day 39% of patients developed type C tympanograms. No member of the control group developed any change in middle ear pressure. There was no significant relationship between pain scores for throat pain or otalgia and the development of negative middle ear pressure. By day 7 all patients had type A tympanograms. Otalgia was a delayed symptom significantly associated with increased throat pain. Transient negative middle ear pressure commonly occurs following tonsillectomy.     

Comparison of diclofenac and tenoxicam for postoperative analgesia with and without fentanyl in children undergoing adenotonsillectomy or tonsillectomy

127 children scheduled for elective tonsillectomy or adenotonsillectomy were studied. Anaesthesia was induced with propofol and maintained with a volatile agent. At induction the child received either rectal diclofenac 1 mg·kg⁻¹ with or without fentanyl 0.75 μg·kg⁻¹ i.v., or intravenous tenoxicam 0.4 mg·kg⁻¹ with or without fentanyl 0.75 μg·kg⁻¹ i.v. Blood loss was measured peroperatively. Nausea and vomiting scores, sedation scores and pain scores were recorded in the recovery room, at one, two, four and eight h postoperatively and at discharge. There were no significant differences in blood loss between the groups or between nausea and vomiting scores. Pain scores in the tenoxicam without fentanyl group were significantly higher in recovery ( P <0.05) than the diclofenac group without fentanyl and both fentanyl groups. This group required supplemental analgesia earlier although this was not significant. The pain scores in the diclofenac with fentanyl group were significantly lower at one h and four h than the group receiving diclofenac alone ( P =0.008 and 0.02 respectively).     

维生素C与维生素K4对减少扁桃体手术术中、术后出血的作用

目的 评价维生素C与维生素K4在减少扁桃体术中、术后出血的作用。方法 将我科2006年6月～12月收治的住院慢性扁桃体炎患者（术后均有病理证实为扁桃体炎）将性别、病程相同、年龄相近者配成一对，随机配对分为两组，共60例，每组30例，试验组给予维生素C与维生素K4口服，对照组给予安慰剂，1周后行常规扁桃体剥离手术。结果 试验组术中出血量最多者18ml，最少者5ml，平均8．26±3．80ml，无1例术后出血；对照组术中出血量最多者38ml，最少者7ml，平均13．42±5．87ml，有1例术后出血。两组比较差异有显著性。结论 口服维生素C和维生素K4对减少扁桃体术中、术后出血有很好的作用。     

Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy

Background : Since pre-incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre- or postoperative local anesthetic infiltration upon post-tonsillectomy pain. Methods : After the induction of general anesthesia, 68 consecutive healthy patients, ranging in age from 8 to 65 years, were randomly allocated to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision. A third group (group 3) had their peritonsillar region infiltrated with 0.25% bupivacaine after the completion of surgery but before the patients were awakened from anesthesia. All the patients were treated in the same way in the postoperative period: NSAIDs were given intravenously to adults and rectally to children. Acetaminophen was given intravenously or rectally (children aged < 15 yr) if additional analgesic support was requested by the patient. Additional acetaminophen consumption was recorded daily. Pain scores were assessed on every patient with the use of a visual analogue scale (VAS) at rest, 1, 5, 9, 13, 17, 21 and 36 h after surgery, and also on swallowing during the first postoperative day. Results : Global VAS pain scores were lower in the groups treated with bupivacaine infiltration during the first 24 h after surgery (P < 0.05). Supplementary analgesic consumption was lower in group 3 than in group 2 during the 0–9 h interval immediately following surgery (P < 0.05). There were no statistically significant differences for any other parameters between the 3 groups. Conclusion : These results suggest that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in patients undergoing tonsillectomy.     

A randomized comparison of three post-tonsillectomy diets*

Traditionally, soft cold foods have been recommended after tonsillectomy to aid comfort and haemostasis but, more recently, rougher foods have been advocated to promote physiologically normal deglutition. This trial was designed to discover whether post-tonsillectomy dietary advice has any influence on recovery. 150 patients due to undergo tonsillectomy were prospectively randomized to 1 of 3 diets: mainly rough food, mainly soft food, and no advice except to eat regularly. Food consumption, analgesia intake and pain levels were recorded daily by each patient. Tonsillar fossa slough and secondary haemorrhage were evaluated 1 and 2 weeks after surgery. Results of 137 patients were obtained. There were no significant differences between the diets regarding post-operative pain, analgesic required, healing rates or secondary haemorrhage. Specific post-tonsillectomy dietary advice need not be given, other than to encourage regular eating.     

“电挤切刀”在儿童扁桃体挤切手术中的应用分析

[目的]探讨“电挤切刀”在儿童扁桃体挤切术中的临床应用效果.[方法]符合扁桃体切除手术指征并符合入选标准的患儿共49例,随机分为实验组和对照组:实验组28例,手术使用“电挤切刀”;对照组21例,手术使用常规挤切刀.对两组手术历时、术中出血量、术后创面反应程度及术后再出血等4项指标进行对比分析.[结果]手术历时:实验组为...