**6. Techniques and technologies**

164 Otolaryngology

The method anesthesia induction and patients' positioning is similar for most patients undergoing tonsillectomy, regardless of which technique is used to remove the tonsils. The patient is placed in the supine position and orally intubated.The endotracheal tube is taped to the patient's chin in the midline. Alternatively, some practitioners prefer to use a laryngeal mask airway.14,15The bed is turned 90°-180° so that the surgeon can sit or stand at the head of the bed. The patient is positioned at the edge of the bed, and a small shoulder roll is placed. Either a Crowe-Davis, McIvor, or Dingman mouth gag is inserted and expanded to keep the mouth open for the duration of the procedure.Tissue tension during complete tonsillectomy is achieved by strong medial traction of Allis clamps and torsion of

50 patients (30 males, 20 females) were studied. 28(56%) had adenotonsillectomy, while 22(44%) had only tonsillectomy alone. The data was obtained by the author from three centres:University of Ilorin teaching hospital, Kwara state, IBB specialized hospital Minna,

35(70%) of the surgeries were performed using cold surgical dissection technique, while 15(30%) were done using bipolar electrocautry. All the surgeries were performed by one of two experienced surgeons. All the children were kept overnight; some were discharged the following day after they can tolerate liquid diet. Routine antibiotics and analgesics were

For the 28 patients who had adenotonsillectomy, the mean operating time for the 8 bipolar

For the 22 patients who had tonsillectomy alone, the mean operating time was 31.4 minutes

Complication of hemorrhage were seen in 3(6.0%) of all the patients, 2(66.7) were in cold

electrocautries was 42.0 minutes and 47.2 minutes for the 20 cold dissection patients.

for the 7 bipolar electrocautries, while 34.2 minutes for the 15 cold dissections.

The tonsils are then removed using 1 of the techniques described later.

**4.2 Surgical procedure** 

the tonsils medially (Figure 3).

Fig. 3. Medial Traction on the Tonsil.

Niger state and Federal medical centre, Azare, Bauchi state.

dissection group and 1(33.3%) in bipolar electrocautry group.

**5. Patients and methods** 

given to all the patients.

The techniques of Tonsillectomy can be broadly divided into 2 major categories: extracapsular (total tonsillectomy, subcapsular) and intracapsular (partial tonsillectomy). Intracapsular is also known as "subtotal," and this procedure is referred to as tonsillotomy in some literatures. Extracapsular tonsillectomy involves dissecting lateral to the tonsil in the plane between the tonsillar capsule and the pharyngeal musculature, and the tonsil is generally removed as a single unit. Partial tonsillectomy, or tonsillotomy, involves removal of most of the tonsil, while preserving a rim of lymphoid tissue and tonsillar capsule in the most recent iteration of this older technique.16 Preservation of this margin of tissue, this "biologic dressing," may promote an easier recovery, with lower hemorrhage rates and better recovery of diet and activity reported in comparison with traditional monopolar tonsillectomy techniques.17,18The most common extracapsular techniques use a "cold" knife (sharp dissection), monopolar electrocautery, bipolar cautery (or bipolar scissors),or harmonic scalpel. Intracapsular techniques may use the microdebrider, bipolar radiofrequency ablation (which can also be used to remove the entire tonsil), and carbon dioxide laser. Either extracapsular or intracapsular tonsillectomy can be performed for the pediatric patient with obstructive sleep apnea, but only extracapsular techniques should be used for patients undergoing tonsillectomy as a result of tonsillitis or peritonsillar abscess. In addition, tonsils can be ablated using a laser or monopolar radiofrequency (somnoplasty) in a cooperative adult in a clinic setting.
