ABSTRACT
It hurts to have one’s tonsils taken out. Whether excised by traditional snare resection, dissection, electrocautery, or laser, the significant postoperative pain is fairly similar (1). The pain, resulting from transected sensory fibers, disruption of overlying mucosa, and spasm of exposed tonsil fossa pharyngeal musculature, typically persists for 7-10 days as exposed tissue heals slowly by secondary intention (2). Resultant problems of poor oral intake with weight loss and dehydration, side effects of frequent and prolonged narcotic analgesic use, and loss of work or school time are well recognized (1,3). In an effort to reduce the discomfort of tonsillectomy when treating obstructive disorders caused by enlarged tonsils, various methods of subtotal reduction (tonsillotomy), such as laser, electrodessication, plasma-mediated ablation technologies, and microdebriders have been introduced. These reduce discomfort by sparing capsule and adjacent tonsil lymphoid tissue, thus avoiding underlying muscle exposure. However, they all ablate overlying mucosa in the process, still leaving a relatively large open wound in the oral cavity with its associated discomfort and other comorbidities. Temperature-controlled radiofrequency (TCRF) soft tissue reduction in the upper airway, a procedure known as Somnoplasty (Gyrus ENT, Bartlett, TN), takes a different approach. For tonsil reduction, it is designed to ablate targeted subsurface lymphoid tissue, effectively shrinking tissue bulk while essentially sparing overlying mucosa and underlying capsule. This accounts for the diminished pain and rapid return to normal activity for both the adult (4) and pediatric (5) patients who have undergone this procedure. It makes tonsil Somnoplasty the least invasive approach to the treatment of tonsil-related obstructive disorders in the upper airway presently available to the practitioner.
