Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-11-2018 | Miscellaneous

Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial

Authors: Fatih Alper Akcan, Yusuf Dündar

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2018

Abstract

Objectives/hypothesis

To investigate the efficacy of a simple and feasible suturing technique on posttonsillectomy pain control and wound healing.

Methods

A prospective, randomized, controlled trial was conducted on a sample of 121 children between 3 and 10 years of age. Group A comprised children undergoing surgery with bipolar cautery and the posterior pillar mucosal suspension technique. Bipolar alone (Group B) and cold dissection tonsillectomy (Group C) were used as control groups. Pain was assessed at 1, 3, 5, 7, and 10 days postoperatively via visual analog scale scores. Peritonsillar edema, erythema, and granulation tissue in the tonsillar fossa were evaluated by direct visual examination for wound healing on days 1, 3, 5, 7, and 10.

Results

There were consecutive 121 patients which were included, with mean ages being 6.2 ± 2.5, 6.1 ± 2.4, and 6.1 ± 2.6 in groups A, B, and C, respectively. Postoperative pain scores on days 1 and 3 were significantly lower in Group A than Group B and C (P < .001) and scores were 0.87 ± 1.1, 3.83 ± 2.29, and 4.29 ± 2.48 on day 1 and 0.38 ± 0.88, 2.25 ± 2.13, and 2.76 ± 2.12 on day 3 respectively. The wound-healing scores on postoperative 1st, 3rd, 5th, and 7th days were significantly lower in Group A than control groups (P < .001). The wound-healing score on postoperative day 10 was only different than Group C (P = .020).

Conclusions

The posterior pillar mucosal suspension technique is an effective and comparable method in terms of wound healing, maintains the preoperative anatomical structures, and enables a better pain control with reduced analgesic/opioid usage.

Whelan RL, Shaffer A, Anderson ME, Hsu J, Jabbour N (2018) Reducing rates of operative intervention for pediatric post-tonsillectomy hemorrhage. Laryngoscope. https://doi.org/10.1002/lary.27076 CrossRefPubMed

Sutters KA, Isaacson G (2017) Posttonsillectomy pain in children. Am J Nurs 114:36–42. https://doi.org/10.1097/01.NAJ.0000443769.04764.65 CrossRef

Aysenur D, Mine C, Ozgur Y, Ahmet AH, Fuat EA, Ilker I et al (2014) Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for relief of post- adenotonsillectomy pain in children: a controlled clinical study. Int J Pediatr Otorhinolaryngol 78:1467–1471. https://doi.org/10.1016/j.ijporl.2014.06.010 CrossRefPubMed

Rakesh S, Anand TS, Payal G, Pranjal K (2012) A prospective, randomized, double-blind study of coblation versus dissection tonsillectomy in adult patients. Indian J Otolaryngol Head Neck Surg 64:290–294. https://doi.org/10.1007/s12070-011-0355-y CrossRefPubMed

Isaacson G (2012) Tonsillectomy care for the pediatrician. Pediatrics 130:324–334. https://doi.org/10.1542/peds.2011-3857 CrossRefPubMed

Belloso A, Chidambaram A, Morar P, Timms MS (2003) Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 113:2010–2013. https://doi.org/10.1097/00005537-200311000-00029 CrossRefPubMed

Stevens MH, Stevens DC (2005) Pain reduction by fibrin sealant in older children and adult tonsillectomy. Laryngoscope 115:1093–1096. https://doi.org/10.1097/01.MLG.0000163496.06073.E7 CrossRefPubMed

Hancı D, Altun H (2015) Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: a prospective, double-blind, controlled clinical study. Int J Pediatr Otorhinolaryngol 79:1388–1392. https://doi.org/10.1016/j.ijporl.2015.07.016 CrossRefPubMed

Genç E, Hancı D, Ergin NT, Dal T (2006) Can mucosal sealing reduce tonsillectomy pain? Int J Pediatr Otorhinolaryngol 70:725–730. https://doi.org/10.1016/j.ijporl.2005.12.005 CrossRefPubMed

10.

Jahanshahi J, Pazira S, Farahani F, Hashemian F, Shokri N, Karkhanei B et al (2014) Effect of topical sucralfate vs clindamycin on posttonsillectomy pain in children aged 6 to 12 years: a triple-blind randomized clinical trial. JAMA Otolaryngol Head Neck Surg 140:698–703. https://doi.org/10.1001/jamaoto.2014.979 CrossRefPubMed

11.

Soy FK, Dündar R, Yazıcı H, Kulduk E, Aslan M (2014) Bipolar cautery tonsillectomy using different energy doses: Pain and bleeding. Int J Pediatr Otorhinolaryngol 78:402–406. https://doi.org/10.1016/j.ijporl.2013.11.005 CrossRefPubMed

12.

Magdy EA, Elwany S, El-Daly AS, Abdel-Hadi M, Morshedy MA (2008) Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection–ligation, monopolar electrocautery and laser tonsillectomies. J Laryngol Otol 122:282–290. https://doi.org/10.1017/S002221510700093X CrossRefPubMed

13.

Ju NY, Cui GX, Gao W (2013) Ropivacaine plus dexamethasone infiltration reduces postoperative pain after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 77:1881–1885. https://doi.org/10.1016/j.ijporl.2013.08.037 CrossRefPubMed

14.

Smith I, Wilde A (1999) Secondary tonsillectomy hemorrhage and nonsteroid anti-inflammatory drugs. J Laryngol Otol 113:28–30. https://doi.org/10.1017/S0022215100143087 CrossRefPubMed

15.

Harley EH, Dattolo RA (1998) Ibuprofen for tonsillectomy pain in children: efficacy and copmlications. Otolaryngol Head Neck Surg 119:492–496. https://doi.org/10.1016/S0194-5998(98)70107-X CrossRefPubMed

16.

Subramanyam R, Varughese A, Willging JP, Sadhasivam S (2013) Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol 77:194–199. https://doi.org/10.1016/j.ijporl.2012.10.016 CrossRefPubMed

17.

Magdalena ML, Caragol L, Sole´ A, Rodrigo JP (2014) Comparison of two analgesic protocols for post-tonsillectomy pain control in outpatient adults. Acta Otorrinolaringol Esp 65:102–108. https://doi.org/10.1016/j.otoeng.2013.10.015 CrossRefPubMed

18.

Faiz SH, Rahimzadeh P, Alebouyeh MR, Sedaghat M (2013) A randomized controlled trial on analgesic effects of intravenous acetaminophen versus dexamethasone after pediatric tonsillectomy. Iran Red Crescent Med J 15:e9267. https://doi.org/10.5812/ircmj.9267 CrossRefPubMedPubMedCentral

19.

Zhang X, Su Y, Li P (2014) Effects of bupivacaine versus lidocaine infiltration on postoperative analgesia in pediatric tonsillectomy patients. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 28:148–150PubMed

20.

Haksever M, Ozmen S, Akduman D, Solmaz F (2014) Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study. Eur Arch Otorhinolaryngol 271:2555–2559. https://doi.org/10.1007/s00405-014-3022-6 CrossRefPubMed

21.

Siupsinskiene N, Zekoniene J, Padervinskis E, Zekonis G, Vaitkus S (2015) Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms. Eur Arch Otorhinolaryngol 272:271–278. https://doi.org/10.1007/s00405-014-3023-5 CrossRefPubMed

22.

Weimert TA, Babyak JW, Richter HJ (1990) Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 116:186–188. https://doi.org/10.1001/archotol.1990.01870020062016 CrossRefPubMed

23.

Parsons SP, Cordes SR, Comer B (2006) Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator and electrocautery. Otolaryngol Head Neck Surg 134:106–113. https://doi.org/10.1016/j.otohns.2005.09.027 CrossRefPubMed

24.

Lachanas VA, Hajiioannou JK, Karatzias GT, Filios D, Koutsias S, Mourgelas C et al (2007) Comparison of liga-sure vessel sealing system, harmonic scalpel and cold knife tonsillectomy. Otolaryngol Head Neck Surg 137:385–389. https://doi.org/10.1016/j.otohns.2007.05.012 CrossRefPubMed

25.

Roth JA, Pincock T, Sacks R, Forer M, Boustred N, Johnston W et al (2008) Harmonic scalpel tonsillectomy versus monopolar diather study. Ear Nose Throat J 87:346–349PubMed

26.

Collison PJ, Weiner R (2004) Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J 83:707–710PubMed

27.

Lavy JA (1997) Post-tonsillectomy pain: the difference between younger and older patients. Int J Pediatr Otorhinolaryngol 42:11–15. https://doi.org/10.1016/S0165-5876(97)00107-9 CrossRefPubMed

28.

Randall DA, Hoffer ME (1998) Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 118:61–68. https://doi.org/10.1016/S0194-5998(98)70376-6 CrossRefPubMed

29.

Sclafani AP, Jacono AA, Dolitsky JN (2001) Grafting of the peritonsillar fossa with an acellular dermal graft to reduce posttonsillectomy pain. Am J Otolaryngol 22:409–414. https://doi.org/10.1053/ajot.2001.28077 CrossRefPubMed

30.

Moon JH, Lee MY, Chung YJ, Rhee CK, Lee SJ (2018) Effect of topical propolis on wound healing process after tonsillectomy: randomized controlled study. Clin Exp Otorhinolaryngol 11:146–150. https://doi.org/10.21053/ceo.2017.00647 CrossRefPubMed

31.

Ozkırış M (2012) Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 269:1497–1501. https://doi.org/10.1007/s00405-011-1777-6 CrossRefPubMed

32.

Setabutr D, Adil EA, Chaikhoutdinov I, Carr MM (2014) Impact of the pediatric tonsillectomy and polysomnography clinical practice guidelines. Int J Pediatr Otorhinolaryngol 78:517–521. https://doi.org/10.1016/j.ijporl.2013.12.035 CrossRefPubMed

Title: Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial
Authors: Fatih Alper Akcan
Yusuf Dündar
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 11/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-5148-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial

Abstract

Objectives/hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives/hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2018

The internal nasal valve: a validated grading system and operative guide

Tri-dimensional model for ventilation tube permeability

A comparison of phonatory outcome between trans-oral CO2 Laser cordectomy and radiotherapy in T1 glottic cancer

The identification of induction chemo-sensitivity genes of laryngeal squamous cell carcinoma and their clinical utilization

Up-regulated lipocalin-2 in pediatric thyroid cancer correlated with poor clinical characteristics

Primary parotid carcinoma: analysis of risk factors and validation of a prognostic index