ABSTRACT
Patient positioning, anesthesia method, and placement of the mouth retractors are
identical to the more conventional methods of tonsillectomy (Fig. 3). In our experi-
ence, a hook blade on a 10 cm handle on power setting of 3 has proven optimal for
tonsillectomy operations. The HS is held like a cold knife and the blunt edge of the
hook blade is used for the entire procedure (Fig. 4). The tonsil is retracted medially
using an Allis clamp (Fig. 5). Starting from the superior portion of the anterior ton-
sillar pillar (mucosal covering of the palatoglossus muscle), the plane of dissection is
defined between the tonsillar capsule and the tonsillar bed. As in conventional ton-
sillectomy, the goal is to minimize the amount of mucosa resected. Due to its mini-
mal lateral thermal dissipation, larger vessels are not as easily coagulated with the
HS as with the monopolar electrocautery. For this reason it is imperative to gently
move the blade medially and laterally while advancing parallel to the tonsillar
capsule to avoid any bleeding. In the highly vascular areas, such as the inferiormost
Figure 3 The patient is positioned as for a traditional tonsillectomy, with a mouth gag of choice positioned to obtain exposure of the oropharynx. (From Operative Techniques in Otolaryngology-Head and Neck Surgery, Vol. 13, No. 2 (Jun), 2002.)
Figure 4 Harmonic scalpel, here shown with hand-controlled buttons, is held like a pen and the dull part of the hook blade used for the dissection. (From Ethicon, Johnson & Johnson.)
part of the anterior and posterior tonsillar pillars, the blade should be advanced very slowly on the ‘‘Variable’’ setting in order to achieve better hemostasis. Should bleeding ensue, gently apply the flat part of the blade for a few seconds using the ‘‘Variable’’ mode (Fig. 6). A white coagulum coats the dissected area after the tonsils are removed, but char is conspicuously absent from the tonsillar fossae (Fig. 7).
