BackTable / ENT / Podcast / Episode #110
Intracapsular Tonsillectomy in Children
with Dr. Kevin Huoh
In this episode of BackTable ENT, Dr. Shah interviews pediatric otolaryngologist Dr. Kevin Huoh about intracapsular tonsillectomy, including the postoperative benefits of the procedure and his personal techniques.
BackTable, LLC (Producer). (2023, May 16). Ep. 110 – Intracapsular Tonsillectomy in Children [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Kevin Huoh
Dr. Kevin Huoh is a pediatric otolaryngologist and assistant professor in Southern California.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
First, Dr. Huoh explains the principle behind intracapsular tonsillectomy. This technique involves removing the tonsil but leaving the capsule intact to protect muscles of the pharyngeal wall and lateral vessels. When he performs this procedure on patients, he notices that their recovery period is less painful and their lower risk of hemorrhages when compared to extracapsular tonsillectomy patients. According to the literature, there is only 3% risk of tonsil regrowth, but he considers regrowth a safer complication than tonsillar hemorrhage. His postoperative recovery regimen includes Tylenol or Motrin for 24 hours, and his patients can start on a regular diet immediately after surgery. Then, he and Dr. Shah discuss differences between American and European guidelines on intracapsular tonsillectomy.
Next, Dr. Huoh explains the type of equipment he uses and his intracapsular tonsillectomy technique. He encourages surgeons to follow their tonsillar regrowth rate, as this data can inform surgeons on whether they are removing enough tissue during the procedure. Additionally, he also emphasizes that it is never too late to learn a new procedure like intracapsular tonsillectomy. He finds it easy to add on an intracapsular tonsillectomy as a minor procedure if he is already taking a patient to the OR for another surgery because of the minimal risks of the procedure. Finally, Dr. Shah and Dr. Huoh discuss tonsillectomies in adults and children with recurrent peritonsillar abscesses.
Smith + Nephew Coblation Technology for Adenotonsillectomy
[Dr. Kevin Huoh]
Just a quick summary on intracapsular tonsillectomy, it's basically involving removing all of the tonsils and leaving a little bit of tissue behind and trying to leave the capsule intact. The principle of it is by leaving a little bit of tissue behind, you don't expose the muscles of the pharyngeal wall, and you don't expose the larger caliber vessels that are more lateral. The hope is that you leave almost a biological dressing overlying the pharyngeal wall.
We've seen that it's been much less painful for our patients and it's lowered the risk of post‐tonsillectomy hemorrhage as well. That's the main premise for intracapsular tonsillectomy because we know most kids now when we're doing tonsillectomy, it's because of OSA or sleep-disordered breathing and it's really the mass of the tonsil that you're trying to remove and intracapsular tonsillectomy does accomplish that.
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