Complete excision versus tonsil ablation for surgical management of tonsillar disease

The surgical approaches and techniques for tonsillar disease have evolved over the years. Complete subcapsular tonsillectomy has traditionally been the procedure of choice for all tonsillar surgery indications. Although new surgical modalities such as ultrasonic-activated scalpel and ionized field ablation appear to decrease the postoperative pain of tonsillectomy, patients continue to have a significant incidence of postoperative hemorrhage. Subsequently, supracapsular partial tonsillectomy has been used for patients with obstructive tonsillar hypertrophy with efficacy equal to that of complete subcapsular tonsillectomy. Partial tonsillectomy seems to offer a less painful postoperative course and a decrease in the complications common after complete tonsillectomy. Although originally the CO₂ laser was used for surgical ablation of the tonsils, ionized field ablation and radiofrequency tissue ablation also have very promising results. The authors conclude that although traditional complete tonsillectomy continues to be the procedure of choice for recurrent infections or chronic tonsillitis, partial supracapsular tonsillectomy is a viable alternative for obstructive disease, offering lower postoperative morbidity with equal efficacy.