State of the Art in Tonsillectomy

Surgical time varied, depending on the device used: It was a mean of 21.6 minutes for the cautery group; 20.2 minutes for the coblation group, and 16.14 minutes in the microdebrider group. Patients returned to a normal diet a mean of 6.36 days, 4.85 days, and 4.59 days in the cautery, coblation, and microdebrider groups, respectively. The differences were statistically significant.

There was also a significant difference in how long it took for patients to return to normal activity levels. This ranged from a mean of 6.57 days, to 4.72 days, to 4.51 days, respectively.

Kids recover faster from coblation or the microdebrider, Dr. Moscatello said. Among the three groups, there was no significant difference in rates of postoperative complications, including problems such as fever or voice change.

Dr. Moscatello noted there are significant differences in the prices of the three devices. The Bovie electrocautery spatula costs only $5.34, whereas the coblator wand for the EVAC-70 costs $370, and the microdebrider blade costs $89.40. When it came to total costs (device and OR cost), they were a mean of $2825.10 for cautery, $3007.06 for coblation, and $2199.03 for the microdebrider.

Cost is something that doctors may want to discuss with patients, especially those who have poor or no insurance coverage, he said. Still, overall recovery time is shorter with use of a coblator or microdebrider-something else to keep in mind.

Tonsillectomy and Sphincter Pharyngoplasty

Could patients benefit from a one-size-fits-all approach to velopharyngeal insufficiency (VPI) after cleft palate repair? This is what is being proposed by a Florida-based surgeon who suggests a possible effective initial intervention, which entails performing a tonsillectomy and sphincter pharyngoplasty as a combined procedure.

VPI is a common consequence in children who were born with clefting of the soft palate, even after the anatomy appears to have been surgically normalized. Children with the problem have speech distortion due to an inability to close the nasopharyngeal airway on the production of phonemes.

It can lead to mild distortions on a few sounds to a complete lack of intelligibility, said John D. Donaldson, MD, Board Chairman at Lee Memorial Health System in Fort Myers, FL.

Children with clefts and other craniofacial abnormalities should be cared for by a multidisciplinary team. The problem is that although anatomy can be relatively well repaired, functional outcome is not always at its best. Over the years, various procedures have been developed and tried to correct VPI with varying levels of success.