**12. Postoperative care**

A majority of children can safely be discharged home on the same day of surgery, regardless of the surgical technique used.10,30Children younger than 2 years or who live far from a hospital should be kept overnight for observation. Pain medication should be recommended, and most physicians prescribe either acetaminophen or acetaminophen with codeine postoperatively.31 Some physicians recommend a soft diet postoperatively, others recommend "diet as tolerated."10 In our centres we commence the child on firstly on cold ice cream and subsequently on liquid diet.

Studies have not shown any difference in recovery between children who have a restricted versus those who have non-restricted diets postoperatively.32,33

A Review of Tonsillectomy Techniques and Technologies 169

[15] Hern JD, Jayaraj SM, Sidhu VS, et al: The laryngeal mask airway in tonsillectomy: The

[16] Koltai PJ, Solares CA, Mascha EJ, et al: Intracapsular partial tonsillectomy for tonsil

[17] Solares CA, Koempel JA, Hirose K, et al: Safety and efcacy of powered intracapsular

[18] Schmidt R, Herzog A, Cook S, et al: Complications of tonsillectomy: A comparison of

[19] Chan KH, Friedman NR, Allen GC, et al: Randomized, controlled, multisite study of

[20] Chang K: Randomized controlled trial of Coblation versus electrocautery tonsillectomy.

[21] Hall MDJ, Littleeld CPD, Birkmire-Peters DP, et al: Radiofrequency ablation versus electrocautery in tonsillectomy. *Otolaryngol Head Neck Surg* 130:300-305, 2004. [22] Leinbach RF, Markwell SJ, Colliver JA, et al: Hot versus cold tonsillectomy: A systematic review of the literature. *Otolaryngol Head Neck Surg* 129:360-364, 2003. [23] Hanasono MM, LalakeaML, Mikulec AA,etal: Perioperative steroids in tonsillectomy

[24] Perkins J, Dahiya R: Microdissection needle tonsillectomy and postoperative pain: A

[25] Stoker KE, Don DM, Kang DR, et al: Pediatric total tonsillectomy using coblation

[26] Shinhar S, Scotch BM, Belenky W, et al: Harmonic scalpel tonsillectomy versus hot

[27] Willging JP,Wiatrak B:Harmonic scalpel tonsillectomy in children:A randomized

[28] O'Leary S, Vorrath J: Postoperative bleeding after diathermy hage:Cold versus hot

[29] Lee MS, Montague ML, Hussain SS: Post-tonsillectomy hemorrhage:Cold versus hot

[30] Mills N, Anderson BJ, Barber C, et al: Day stay pediatric tonsillectomy—A safe

[31] Moir MS, Bair E, Shinnick P, et al: Acetaminophen versus acetaminophen with codeine

[32] Brodsky L, Radomski K, Gendler J: The effect of post-operative instruction on recovery

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prospective study. *Otolaryngol Head Neck Surg* 128: 318-325, 2003.

study. *Otolaryngol Head Neck Surg* 130:666-675, 2004.

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dissection.*Otolaryngol Head Neck Surg131*:833-836,2004.

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140,1993

#### **13. Long-term follow-up**

Typically, the patient will be seen in the office in 2 weeks, then 1 month of the tonsillectomy to conrm adequate healing, although it is also acceptable to follow-up with a phone call only.10,34

#### **14. Conclusions**

Appreciation of the indications and the use of new tonsillectomy techniques and technologies, as well as an awareness of the economic ramications of their adoption, will ultimately provide the best care for tonsillectomy patients.

#### **15. References**


Typically, the patient will be seen in the office in 2 weeks, then 1 month of the tonsillectomy to conrm adequate healing, although it is also acceptable to follow-up with a phone call

Appreciation of the indications and the use of new tonsillectomy techniques and technologies, as well as an awareness of the economic ramications of their adoption, will

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**13. Long-term follow-up** 

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**14. Conclusions** 

**15. References** 

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**1. Introduction** 

treatment modalities.

two most robust etiologic factors.

management lies in which modality to select.

**3. Management** 

**11** 

*Canada* 

**Management of Early Glottic Cancer** 

The management of early glottic cancer has evolved significantly over the past decade, with transoral laser (TOL) surgery and radiotherapy emerging as the two most prevalent treatment modalities. The selection of one modality over another continues to generate controversy. With both modalities showing similar efficacy with regard to survival and oncologic outcomes, the selection of one modality over another hinges upon vocal function, quality of life, and cost-effectiveness as the main outcomes of interest. This chapter will begin with a brief overview of the epidemiology and presentation of glottic cancer and will follow with a comprehensive overview of the contemporary literature comparing both

Laryngeal cancer is the most common malignancy of the upper aerodigestive tract (Fowler, 1997) with Surveillance Epidemiology and End Results (SEER) data estimating that 12,720 men and women (10,110 men and 2,610 women) were diagnosed with laryngeal cancer in 2010. This data estimated that 3600 men and women will die as a result of the disease. The age-adjusted incidence rate was 3.4 per 100,000 men and women per year, and the median age at diagnosis was 65 years of age (SEER, 2011). Squamous cell carcinoma constitutes the overwhelming majority of laryngeal malignancies, with smoking and alcohol abuse as the

Malignancy most commonly affects the glottic subsite of the larynx, and the glottis accounts for two thirds of primary laryngeal cancers. Carcinomas of the glottis produce dysphonia at an early stage, and because of poor lymphatic drainage tend not to present with nodal disease (Bouqet, 1988; Groome et al., 2001; Shah et al., 1997). Both of these features allow for

Radiotherapy and conservation surgery are the two viable treatment modalities employed in the management of early glottic cancer, with concurrent chemoradiotherapy and radical surgery reserved for advanced disease. The controversy in early glottic carcinoma

**2. Epidemiology and clinical presentation of glottic cancer** 

single modality therapy of glottic carcinoma in the majority of patients.

Luke Harris, Danny Enepekides and Kevin Higgins

*Sunnybrook Health Sciences Centre, Toronto* 

