Fatih OGHAN, Ali GUVEY, Onder AYDEMİR, Onur ERDOGAN, Muhammet Fatih TOPUZ, Metin CELİKER, Suat TERZİ, Seckin AKBAL

Comparison Of Post-Tonsillectomy Morbidity In Cases Of Sleep Apnoea Where Surgery Employed Either Cold Knife Or Coblation Techniques

Objective: To compare the snare and coblation methods in terms of post-tonsillectomy morbidity for patients with obstructive sleep apnoea. Method: The study involved 49 cases. Twenty-one patients were operated on using the snare method, whilst the remaining 28 patients underwent coblation tonsillectomy. The amount of intraoperative bleeding was recorded. The pain level at the 6th and 12th postoperative hour was assessed. On postoperative days 1, 3 and 7, the patients were assessed through VAS (Visual analogue scale) and Wong-Baker Faces Pain Rating Scale (WBFPRS). The two groups were then compared. The Tonsillar Fossa Wound Healing Score (TFWHS) assessment was also undertaken to assess wound healing rates on postoperative days 1, 3, 5, 7 and 10. Results: The patients who underwent coblation had significantly lower amounts of bleeding compared to those whose operations employed the snare method (p=0.046). Those patients who underwent tonsillectomy using the snare method had significantly higher 6th hour VAS and WBFPRS scores (p=0.011, p=0.005) than the other group. In contrast, VAS and WBFPRS scores at the 12th hour postop and on days 1, 2, 3 and 7 were similar between the groups. TFWHS for those who underwent coblation were significantly higher on days 1 and 3 (p=0.007; p=0.008). However these scores were similar on days 5, 7, and 10. Conclusion: The research indicates that the amount of intraoperative bleeding in cases undergoing coblation is significantly lower. Lower pain in the early postoperative period, resulting in earlier oral intake and better recovery scores for the tonsillary fossa seem to be the advantages of coblation as opposed to the snare method. Key words: Tonsillectomy, Morbidity, Tonsillar Hypertrophy, Sleep Apnoea

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1. Curtin JM. The history of tonsil and adenoid surgery. Otolaryngol Clin North Am 1987;20:415-419.

2. Wiatrak BJ, Wooley AL. Pharyngitis and adenotonsillar disease. In: Cummings CW, Fredrickson JM, Schuller DE, eds. Otolaryngology Head and Neck Surgery, ed 3 Mosby; 1998. p. 188-215.

3. Younis RT, Lazar RH. History and current practice of tonsillectomy. Laryngoscope 2002;112:3-5.

4. Clenney T, Schroeder A, Bondy P, Zizak V, Mitchell A. Postoperative pain after adult tonsillectomy with PlasmaKnife compared to monopolar electrocautery. Laryngoscope. 2011;121(7):1416-21.

5. Chang KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol Head Neck Surg 2005;132:273-80

6. Chinpairoj S, Feldman MD, Saunders JC, et al. A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model. Laryngoscope 2001;111:213-7.

7. Brodsky L. Tonsillitis, tonsillectomy and adenoidectomy. In: Bailey BJ., ed. Head and Neck Surgery-Otolaryngology, Philadelphia: Lippincott; 1993: 833-47.

8. Magdy EA, Elwany S, el-Daly AS, Abdel-Hadi M, Morshedy MA. Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 2008;122: 282–290.

9. Lowe D, van der Meulen J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004;364:697-702.

10. Lee KC, Altenau MM, Barnes DR, et al. Incidence of complications for

subtotal ionized field ablation of the tonsils. Otolaryngol HeadNeckSurg 2002;127:531-8.

11. Belloso A, Chidambaram A, Morar P, et al. Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 2003;113:2010-3.

12. Polites N, Joniau S, Wabnitz D, Fassina R, Smythe C, Varley P, Carney AS. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg. 2006;76(4):226-9.

13. Timms MS, Temple RH. Coblation tonsillectomy: a double blind randomized controlledstudy. J Laryngol Otol. 2002; 116: 450-452.

14. Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol HeadNeckSurg. 2004;130(6):666-75.

15. Friedman M, LoSavio P, Ibrahim H, et al. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope 2003; 113:882-7

16. Back L, Paloheimo M, Ylikoski J. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults. Arch Otolaryngol HeadNeckSurg 2001;127: 1106-12.

17. Chinpairoj S, Feldman MD, Saunders JC, Thaler ER. Laryngoscope. A comparison of monopolar electrosurgery to a new multipolar electrosurgical system in a rat model. 2001;111(2):213-7.

Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J, Yung M, Brown P. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope. 2007;117(4):717-24.