The “Swiss-cheese Doppler-guided laser tonsillectomy”: a new safe cribriform approach to intracaps
Prof. Beniamino Palmieri Chirurgo generale, Chirurgo maxillo facciale, Chirurgo plastico, Ematologo
Outpatient laser ablation of palatine tonsils is a veryinteresting procedure that has been recently introduced as aroutine in head and neck surgery departments. The aim of thisstudy was to describe a new strategy using a Doppler-guidedfibre optic neodymium-yttrium–aluminium–garnet (YAG) la-ser to remove up to 80 % of tonsillar tissue, as assessed in thelong-term postoperative clinical evaluation ofthe volume of thetonsils at the follow-up, and leaving the capsule in place, thusavoiding any haemorrhagic complication and minimize pain. Atotal of 20 patients (men, n013; women, n07), aged between 6and 63, were recruited for the procedure. They were affected bychronic hypertrophic tonsillitis with a recurrent fever and othersymptoms that were related to oral inflammation. Among the20 patients, no serious adverse events, including haemorrhage-related complications, were observed. Treatment was well tol-erated, even in patients displayinganoverall lowpainthresh-old. No dropout or uncompleted procedure occurred in thepresent study. Minor complications included sore throat, mod-erate oedema, mild acute pharynx inflammation, slight periton-sillar exudate and local burning. The postoperative pain, measured by Scott–Huskisson visual analogue scale, was be-tween 5 and 40 mm and was easily counteracted by means ofexternal ice packages and nonsteroidal anti-inflammatory drugs,according to the individual patient’s need. During the 12–36-month follow-up patients showed improved symptoms (n=7)and complete recovery (n=13). A relapse episode was observedin two patients. This study supports fibre optic laserneodymium-YAG tonsil surgery, named “cribriform intracapsu-lar tonsillectomy” or “Swiss-cheese laser tonsillectomy”,asaneffective alternative to the traditional cold knife approach orelectrosurgery. This approach could become the gold standardfor tonsil surgery in the third millennium for safety reasons,acceptable cost–benefit ratio, the precise targeting of the beamacrosstheaffectedtissuesandtheshort-andlong-termrecovery.
Data pubblicazione: 20 gennaio 2015