Tonsillectomy-slides-050427

Tonsillectomy-slides-050427 - The Modern Tonsillectomy UTMB...

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Unformatted text preview: The Modern Tonsillectomy UTMB Dept of Otolaryngology April 27, 2005 Murtaza Kharodawala, MD Matthew Ryan, MD History Indications Innovative Techniques and Comorbidites Intracapsular tonsillectomy Harmonic scalpel Laser Coblation Adjuvant Therapy Local Anesthesia: Bupivacaine Perioperative Dexamethasone Postoperative Antibiotics Current Practice Patterns History Aulus Cornelius Celsus 1 st Century AD the tonsils are loosened by scraping around them and then torn out with a finger Used vinegar and medication for postoperative hemostasis Aetius of Amida 6 th Century AD Hook and knife method Philip Syng Physick (Father of American surgery) First to develop the tonsillotome Mackenzie Late 1800s Made tonsillotome use common Partial versus complete tonsil removal 1906 William Lincoln Ballenger recommended complete removal of tonsil with the capsule intact 1909 George Ernest Waugh credited as first to describe complete tonsillectomy 1911-1917 Crowe reviewed 1000 tonsillectomies Use of Crowe-Davis mouth gag Sharp dissection History In U.S. 1959: 1.4 million tonsillectomies performed 1979: 500,000 1985: 340,000 1996: 287,000 In 1950s and 1960s chronic infection primary surgical indication Now, airway obstruction and obstructive sleep apnea more common indications Improvement in medical management with Abx History Indications AAO-HNS published guidelines in 1995 Clinical Indicators Compendium Tonsillar disease refractory to medical therapy 3/+ infections/year Hypertrophy Dental malocclusion Orofacial growth affected Upper airway obstruction Dysphagia Sleep disorders Cardiopulmonary complications Peritonsillar abscess Halitosis due to chronic tonsillitis Chronic/recurrent tonsillitis with Strep carrier state Unilateral hypertrophy, presumed neoplasm American Academy of Otolaryngology-Head and Neck Surgery: 1995 Clinical indicators compendium , Alexandria, Virginia, 1995, American Academy of Otolaryngology-Head and Neck Surgery Indications Paradise et al, 1984 Parallel randomized and non-randomized clinical trials to evaluate the efficacy of tonsillectomy in the pediatric population with recurrent pharyngitis Criteria 7/+ episodes in last 1 year 5/+ episodes in last 2 years 3/+ episodes in last 3 years Clinical features of each episode Fever Lymphadenopathy Tonsillar/pharyngeal exudate Positive -hemolytic streptococcus test Medically treated Paradise et al Paradise conclusions Tonsillectomy was efficacious for 2 years and possibly a third in reducing frequency and severity of subsequent episodes Paradise criteria adopted by many otolaryngologists Paradise et al Paradise et al, 2002 2 parallel randomized controlled trials to evaluate efficacy of tonsillectomy in moderately affected...
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Tonsillectomy-slides-050427 - The Modern Tonsillectomy UTMB...

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