Ultrasonographic assessment of tonsillar volume in children

Sir, we read with great interest the recent article by Asimakopoulos et Al. entitled \u201cUltrasonographic assessment of tonsillar volume in children\u201d1. The study has been well planned and we would like to appreciate the effort made by the Authors to shed light on this topic. However there are few points regarding the methodology with which we have some reservations and would like to highlight these through your prestigious journal . First, the clinical utility of tonsillar volume as a predictor of OSAS severity has not been clearly demonstrated despite its widespread use. The etiologies of pediatric OSAS are diverse. Tonsil size is not the sole factor and this could explain why tonsillectomy is not 100 % curative2. Because the tonsils are larger relative to the airway size a better way to assess tonsil size clinically is to evaluate the tonsils within a more 3-dimensional/volumetric framework to capture the impact of the tonsils on the upper airway. Second, since in the paper by Asimakopoulos et Al indication for tonsillectomy was recurrent tonsillitis in about 70% of the patients, it could be hasty to conclude that \u201cPreoperative ultrasound assessment of tonsillar anatomy and size may be an additional and suitable, objective method in the development of a risk stratification system in children with obstructive sleep apnoea undergoing tonsillar surgery\u201d. Certainly, as supposed by the Authors, tonsillar ultrasound may have a role to assess for tonsillar asymmetry and potentially prevent patients from undergoing unnecessary diagnostic tonsillectomies. Finally, even if assessment of tonsils size is an effective screening tool for the clinical diagnosis of paediatric OSA , the true effect of tonsils volume on sleep disordered breathing requires further exploration. Particularly, in the case of a child who may be at higher risk for complications during surgery only a PSG may have real value in firmly establishing the risk of postoperative respiratory compromise potentially needing for ICU overnight observation3

Single centre analysis of perioperative complications in trans-oral robotic surgery for oropharyngeal carcinomas

Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was conducted to show the rates of peri-operative complications after TORS for OPSCC in our experience. Single centre retrospective analysis of consecutive OPSCC treated with TORS. The surgical complication severity was recorded according to Clavien-Dindo criteria (CDC). Eighty-seven OPSCC were operated with TORS. According to CDC, grade I, grade II and IIIb were registered in 8%, 4.6% and 11.5% of cases, respectively. The postoperative pain, registered with visual-analogue scale (VAS) score, was 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions (p < 0.01). The impact on swallowing function was not significant between secondary healing and flap reconstructions(p = 0.96). Any major or life-threatening intraoperative complications have not been recorded. Only one patient had postoperative bleeding into the neck whilst 13.3% of patients had postoperative bleeding from the primary tumor. No total local or free flap failure were registered. The mean duration of tracheostomy use was 7.4 ± 2.6 days, and nasogastric tube 14.3 ± 6.9 days. Only one patient, who had also reconstruction with flap, experienced a postoperative severe dysphagia with severe aspiration, needing a permanent tracheostomy tube and percutaneous endoscopic gastrostomy feeding. TORS for OPSCC showed less morbidity, lower risk of severe complication and mortality. Thus, this treatment modality could be offered as first line treatment in selected cases