In recent years, consolidation of tonsillar
hypertrophy as the principal
surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (
tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and
postoperative hemorrhages and
pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2)
laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar
hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of
infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive
tonsillitis. Recently, alternatives to classical
adenoidectomy using adenoid curette have also appeared.
Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial
adenoidectomy, which is preferred in patients at risk of
velopharyngeal insufficiency.