Pediatria pre prax 6/2016

Tonsillotomy in childhood

In the article the authors inform about classification of performances on palatine tonsils, at present divided into extracapsular (tonsillectomy) and intracapsular ones (tonsillotomy, subtotal partial tonsillectomy). Subsequently they concentrate on the definition, indications and complications in tonsillotomy in the childhood. More precisely they analyse the main indication for tonsillotomy, which is hyperplasia of palatine tonsils conditioning snoring or OSAS. In small children adenotomy is often necessary for removal of a mechanic obstruction in the area of epipharynx. The technique chosen for tonsillotomy does not have any influence on the result of surgery, most often cold instruments, lasers, microbriders, radiofrequency or coblation are applied. In conclusion the authors provide information on new trends for indication of tonsillotomy and tonsillectomy presented as a new professional Guideline S2k-017/024 AWMF by the German society for ENT, paediatrics and infectology based on EBM knowledge. It is recommended to apply tonsillotomy for solution of several indications where at present tonsillectomy is indicated. The age for possible operated patients is extended from original 3-8 years to all age groups. In their opinion the term chronic tonsillitis should not be used. According to their conclusion there exist only acute or recurring tonsillites. A new opinion is brought also on the solution of focal infection in the area of palatine tonsils. In the Slovak reality it is necessary to find an interdisciplinary consensual viewpoint respecting this recommendation in the needs of practice and to apply the McIsaac score in assessing tonsillites.

Keywords: tonsillotomy, indication, Guideline S2k-017/024 AWMF