Intracapsular Tonsillectomy in Pediatric OSA: Technique and Perioperative Care (AMW)
2021 AAO-HNSF Annual Meeting & OTO Experience
Tonsillectomy is one of the most performed surgeries in children. While previously the main indication for tonsillectomy was chronic or recurrent tonsillitis, most tonsillectomies are now performed for sleep disordered breathing and obstructive sleep apnea. Since Koltai et al. described the approach and potential merits of intracapsular tonsillectomy in 2002, the procedure has steadily gained popularity in the United States and across the world as an alternative to traditional extracapsular tonsillectomy. The advantages of intracapsular tonsillectomy are documented across numerous retrospective and prospective clinical studies as well as randomized control trials. A recent meta-analysis of randomized control trials concluded that intracapsular tonsillectomy demonstrates a reduced incidence of postoperative hemorrhage, reduced postoperative pain, reduced need for analgesics, more rapid rate of return to normal diet, and fewer days returning to normal activity. Despite these clear advantages and the increasing number of senior pediatric otolaryngologists advocating for a paradigm shift towards intracapsular tonsillectomy, the current incidence of intracapsular tonsillectomy being performed in the United States is approximately 20% as determined by a national survey of pediatric otolaryngologists conducted by the speakers. In order to increase the adoption of intracapsular tonsillectomy, general otolaryngologists and pediatric otolaryngologists already in practice need further instruction and guidance on the technique which is not difficult to learn. The goals of this expert series course are to provide guidance into the perioperative management of patients undergoing intracapsular tonsillectomy; introduce the technique of intracapsular tonsillectomy; and to provide expert guidance on the nuances of the intracapsular tonsillectomy technique. By the end of the course, the otolaryngologist should feel more comfortable with the technique of intracapsular tonsillectomy and be ready to introduce it into their practice.
Credits
CME:1.0, MOC:1.0