Jonas Graf

Pediatric tonsillotomy with radiofrequency technique: long-term follow-up.

Objectives: Compare the effects of partial tonsil resection using a radiofrequency technique, tonsillotomy (TT), with total tonsillectomy (TE, blunt dissection) after 1 and 3 years. Compare frequency of relapse in snoring or infections and possible long‐term changes in behavior among TT children with those in TE children.

Oral motor dysfunction in children with adenotonsillar hypertrophy—effects of surgery

Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n=33) or partial tonsillectomy, ‘tonsillotomy’ (n=34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

Sublingual administration of atropine eyedrops in children with excessive drooling – a pilot study

Background Drooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable. Aim To analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities. Design The study had a prospective, single‐system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents’ rating of their childs drooling was assessed on a 100‐mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality. Results Parents’ VAS assessment of drooling decreased from a median (range) of 74 (40–98) at baseline to 48 (18–88) (P = 0.05) and 32 (12–85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted. Conclusions Sublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.

Intracapsular tonsillectomy with RF surgery versus regular tonsillectomy: One-year results

Problem: To compare 2 techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and the long-term (that is, 1 year) effects on snoring and recurrent tonsillitis. Methods: Ninety-two children with a history of snoring and (few to several of them) tonsillitis, were randomized to either regular tonsillectomy (T)(n = 43) or intracapsular tonsillectomy (TT) using the radio-frequency (RF) surgical technique (n = 49). Surgitrone™ (Ellman int) 1.7 MHz was used with specially made sling electrodes. Results: In the TT group, the children recorded less pain from the second hour after surgery onward and were back in school and pain-free 3 days earlier than children in the T group. The TT children used fewer doses of painkillers and did not lose weight postoperatively compared to the T-group children who lost a mean of 660 g in 10 days. One year after surgery, both groups were satisfied and in good health. The T-group children remembered their pain as a trauma. The positive effect on snoring was the same in both groups and recurrence of infections had not occurred in a significant higher degree in the TT group. Conclusion: Intracapsular tonsillectomy with RF surgery is a safe method; it causes less pain and morbidity than regular tonsillectomy and has the same effect on snoring and recurrence of infections. Significance: A surgical technique that results in less suffering and a shorter length of time the child and a parent have to stay at home postoperatively is a health gain, as well as a socioeconomic one. Is it defendable to continue performing traditional tonsillectomy? Support: Financial support from the Research Council of South East Sweden (FORSS). Technical support from Ellman int.inc, NY, USA, which has provided with specially made electrodes.