Tonsillectomy for obstructive sleep apnea: Is it necessary to breach the capsule?

<p>Anurag Jain</p>

Tonsillectomy for obstructive sleep apnea: Is it necessary to breach the capsule?

Anurag Jain

Queens Hospital, UK

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Abstract

There is an increasing recognition of obstructive sleep apnea in addition to recurrent tonsillitis, as an indication of adenotonsillectomy, which is often seen in much younger kids. Post-operative pain, risk of bleeding and at least two weeks of recovery time and especially in kids less than 4 years of age makes this procedure with significant post-operative risks. However, the recognition of the tonsillar capsule as a watershed with the blood vessels lateral to it on an average double the diameter when compared to its medial, as well as absence of the sensory nerve endings medial to it, is rather promising. This is especially in cases of obstructive sleep apnea where, reduction in bulk of adenoids and tonsils is only required. Therefore, ablation of tonsils medial to the capsule with cold radiofrequency ablation (coblation) has much lower incidence of bleeding (0.4% vs. 4% by conventional techniques) and postoperative pain with much quicker recovery in the post-operative period. Its role in performing tonsillectomy in cases of recurrent tonsillitis is more controversial due to risk of tonsillar remnants getting infected. The author describes and presents the mechanism of action of coblation intra-capsular tonsillectomy and his experience in performing this procedure.