Tonsillotomy

Tonsillotomy (from Latin tonsillae, meaning tonsils, and Ancient Greek τέμνω, meaning to cut, to dissect) is a surgical procedure involving partial removal (volume reduction) of the palatine tonsils. The key difference from tonsillectomy is that only the portion of the tonsil protruding into the pharyngeal airway is removed, while the tonsillar capsule and the base are preserved.

The primary goal of this surgical procedure is to eliminate mechanical airway obstruction caused by excessively enlarged tonsils. Preservation of a portion of lymphoid tissue allows the tonsils to retain some immunologic function.

Indications for Tonsillectomy

Tonsillotomy is a procedure of choice exclusively for obstructive indications. It is not performed for chronic infectious tonsillar disease.

The main and virtually the only indication is hypertrophy of palatine tonsils causing breathing disorders:

• Obstructive sleep apnea syndrome (OSAS): The main indication, especially in pediatric patients. Reduction of the volume of the tonsils leads to airways widening and normalizes breathing during sleep.
• Severe snoring (rhonchopathy), caused by enlarged tonsils.
• Dysphagia: In rare cases, when massively enlarged (“kissing”) tonsils interfere with swallowing.

The procedure is most commonly performed in children with hypertrophied palatine tonsils.

Tonsillotomy is contraindicated in patients with recurrent acute tonsillitis or decompensated chronic tonsillitis, as the remaining tonsillar tissue may continue to serve as a focus of infection. In such cases, complete tonsillectomy is indicated.

Surgical Technique and Advantages

The procedure is always performed under general anesthesia. The surgeon’s objective is to remove the protruding portion of the tonsil without damaging its capsule and the underlying pharyngeal musculature. Contemporary techniques include:

• Coblation (cold plasma tonsillotomy): Considered the gold standard. Allows precise tissue dissolution with minimal thermal damage.
• Shaver (microdebrider) tonsillotomy: Uses a special instrument (shaver) that cuts and aspirates tonsillar tissue.
• Laser and radiofrequency techniques.

Advantages over complete tonsillectomy:

• Significantly less postoperative pain: Pharyngeal muscle bed remains intact.
• Faster patient recovery: Earlier return to normal diet and daily activities.

Clinical Significance and Outcomes

Tonsillotomy is a highly effective and safe treatment for pediatric obstructive sleep apnea caused by tonsillar hypertrophy. Its effectiveness in relieving airway obstruction is comparable to that of tonsillectomy, while offering a more favorable safety profile. A potential disadvantage is the theoretical risk of regrowth (recurrent hypertrophy) of the remaining lymphoid tissue; however, this occurs infrequently in clinical practice. The choice between tonsillotomy and tonsillectomy is always based on the primary indication for surgery: airway obstruction or chronic infection.