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Abstract
Electrocautery tonsillectomy is a common method of tonsil removal,
and electrocautery devices are widely available. Although these devices
are relatively safe, inadvertent patient injury may occur with their
use, such as oral cavity burns. We describe a simple surgical technique
that reduces the risk of oral burns during electrocautery tonsillectomy
and review additional safety considerations.
Introduction
Electrocautery tonsillectomy continues to be the most common
technique used to remove hypertrophic tonsils despite the introduction
of new technologies such as the laser, the microdebrider, coblation, and
the harmonic scalpel. Decreased intraoperative bleeding rates, improved
operative times, and overall cost savings compared to those of
"cold knife" techniques have contributed to this trend.
Electrocautery devices are widely available and commonly used for
many routine head and neck surgical procedures. While these devices are
relatively safe, inadvertent patient injury may occur due to the
malfunction or improper use of surgical devices, errors in surgical
technique, carelessness of operating room personnel, or a combination of
these factors. Multiple accounts of inadvertent oral cavity burns during
electrocautery tonsillectomy have been documented in the medical
literature. It is likely that many more such injuries occur but are not
reported.
We present a simple surgical technique that greatly reduces the
injury, but the added time and expense involved may be a deterrent to
their use in clinical practice. Conversely, our described technique of
electrocautery handpiece operation adds no extra time or cost to the
procedure and can be practiced routinely in any operative setting,
regardless of the availability of electrocautery accessories.
The technique we have described is simple and straightforward. It
is not difficult to learn, and continued practice makes it second nature
for the operating surgeon. This technique will decrease the risk of
inadvertent oral cavity burns during tonsillectomy and other surgeries
of the oral cavity by creating a physical barrier and electrical
insulator between the electrocautery handpiece and patient's oral
tissues.
We also suggest that as an adjunct to this technique, preoperative
and intraoperative inspection of the electrocautery handpiece and tip be
carried out by the operating surgeon and assistant, to ensure that the
tip is firmly seated in the handpiece. Additionally, using minimum power
settings, activating the handpiece only while in contact with the
patient, and avoiding close contact between the tip and metallic devices
within the mouth will help avoid unintentional injury. (7)
Adenotonsillectomy is one of the first surgical procedures an
otolaryngology resident learns. An inexperienced resident may become
focused on the tonsillar tissue and lose awareness of the entire
surgical field. Employing this technique helps new surgeons develop that
awareness, which translates to increased safety for the patient and
decreased risk of complications. We recommend the teaching of the
described tonsillectomy technique to otolaryngology residents and