1993 Volume 1993 Issue Supplement61 Pages 133-140
Adenotonsillectomy is frequently performed on children with upper airway obstruction, since the most common cause is adenotonsillar hypertrophy. Removal of a minimal amount of tonsil tissue may be immunologically better, however, removal of a wider area may be necessary to enlarge the airway sufficiently. Based on the foregoing, removal of the palatine tonsil on only one side and adenotomy (hemitonsillectomy and adenotomy: HTA)was performed in 6 cases of upper airway obstruction in patients under 5 years old. Five of these cases underwent nocternal polygraphic recordings before and one week after HTA. Airflow, thoracic movement, mesopharyngeal pressure and oxygen saturation were simultaneously monitored and the following results were obtained: the maximum amplitude of mesopharyngeal pressure remarkably decreased, and the minimum oxygen saturation increased to a normal range postoperatively.
Although all cases had good long te r m courses, two, both 5 years old, complained of snoring and sleep apnea again 30 or 37 months after HTA. On physical examination, the remaining palatine tonsils had hypertrophied while pharyngeal lymph follicles had not hypertrophied. Funnel chest, which had been observed in one of the 2 cases before HTA, had already completely disappeared. On polysomnographic examination, recurrence of upper airway obstruction was demonstrated. The remaining palatine tonsils were removed and thereafter the 2 cases improved both clinically and on the polygraphic test.
The remaining 4 cases were investigated by questionnaires, which sho w ed that they had no recurrence 5 to 39 months postoperatively. Pigeon chest, which had been observed in one of the 4 cases before HTA, had slightly improved.
These results suggest that HTA is valuable for preservation of immunological function, improvement of chest deformity and reduction of compensatory hypertrophy of Waldeyer's ring. Considering these advantages, HTA is considered a useful treatment for children under 5 years old with upper airway obstruction, although additional surgical treatment may be required in some cases due to recurrence of upper airway obstruction.
