Radiofrequency tonsillotomy versus bipolar scissors tonsillectomy for the treatment of OSAS in children: a prospective study.

INTRODUCTION: Tonsillotomy is an effective treatment for the management of obstructive sleep apnoea syndrome (OSAS) in children with tonsillar hypertrophy and appears to be associated with less pain and postoperative morbidity. OBJECTIVE: To compare postoperative morbidity and short-term and intermediate-term efficacy of radiofrequency tonsillotomy (TT) and bipolar scissors tonsillectomy (TE) in children. PATIENTS AND METHODS: Children with OSAS due to tonsillar hypertrophy were included in a prospective, non-randomized study between February 4, 2008 and March 20, 2010. Exclusion criteria were recurrent tonsillitis (≥ 3 episodes per year), clotting disorders and age less than 2 years. Postoperative complications, efficacy on OSAS, and operating times were evaluated. Pain was evaluated by the Postoperative Pain Measure for Parents score on D0, D1, D7 and D30. RESULTS: One hundred and ninety-three children were included: 105 in the TE group (age: 4.75 ± 2.37 years) and 88 in the TT group (age: 4.88 ± 2.6 years). The pain score was significantly lower in the TT group than in the TE group during the first postoperative week (P<0.05). A significant difference was observed for the secondary postoperative bleeding rate (1 after TT versus 8 after TE). No significant difference was observed between the two techniques in terms of the efficacy on OSAS. At 1 year, the tonsil regrowth rate in the TT group was 4.5%. CONCLUSION: Radiofrequency tonsillotomy is a safe technique for the treatment of obstructive tonsillar hypertrophy in children with good results on OSAS and a reduction of postoperative pain.

Type III-IV laryngotracheoesophageal cleft: report of a successfully treated case.

This report presents a case of Stage III laryngotracheoesophageal cleft (LTEC). It is, to our knowledge, the fourth case in which the patient is still alive twenty months after surgery. We herein describe an initial symptomatology dominated by a bubbling hypersalivation, our surgical technique using a pleural shred of interposition and an endoscopic check during the operation and, finally, the clinical development dominated by a food intake refusal which was progressively improved through psychiatric help.

[Need for multidisciplinary care management in the treatment of type III laryngo-tracheo-esophageal cleft]. / La nécessité d'une prise en charge pluridisciplinaire dans le traitement des diastèmes laryngo-trachéo-cesophagiens de type III.

We report a case of type III laryngotracheoesophageal cletf. To our knowledge, this case represents the fourth case repaired. Survival was 22 months. The surgical repair we describe here is the first condition to survival. Close collaboration initially with anesthesiologists, then with the intensive careteam unit is required for post-operative management. Moreover, in addition to the surgical trauma, post-operative management is often long with tracheotomy and gastrostomy leading to a corporeal schema disorder in swallowing and respiration. Early psychologic assistance is indispensable to a good functioning of the aero-digestive region.

[Blue rubber bleb naevus syndrome. Diagnosis and management apropos of 2 cases]. / Blue Rubber Bleb Naevus Syndrome. Diagnostic et conduite à tenir à propos de deux cas.

Blue Rubber Bleb Naevus Syndrome is a rare pathology: 70 cases have been noted since the first description, by Gascoyen, in 1860. It is an acquired disease which usually appears before the age of ten. It is marked by angiomatic cutaneo-digestive tumours combined with chronic anaemia and iron deficiency. Its many and various complications, particularly cataclysmic haemorrhages, car jeopardize the vital prognosis throughout. This little known syndrome is rarely diagnosed at the time of its first manifestations. We recall, from two cases and a review of their literature, the clinical characteristics of the syndrome, its complications and its essentially symptomatic treatment. We therefore suggest an approach to its diagnosis.

[Pharyngeal obstruction caused by tonsil hypertrophy in children]. / L'obstruction pharyngée d'origine amygdalienne chez l'enfant.

Tonsillectomy for enlarged tonsils has been so soundly criticized that doctors no longer date to suggest the operation. If they do come to the conclusion that the procedure in inevitable, it is only after an expensive and sometimes aggressive work-up. In order to better establish the criteria which should determine this indication for amygdalectomy, we studied a series of 47 patients undergoing this procedure for enlarged tonsils. We conclude that it is most important to base decisions on a thorough physical examination which includes careful inspection of the pharynx and a complete history. Particular attention must be paid to symptoms, especially nocturnal, and to the failure to gain weight.