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This is a comprehensive study comprising 157 children who underwent tonsillectomy below the age of two years, mainly for sleep-disordered breathing (86.6%) and recurrent tonsillitis (7%). With relatively recent understanding of OSAS, the indications for tonsillectomy in children under two years has risen from 0.07% according to the 2005 UK National Prospective Tonsillectomy Audit, to 3.7%, as noted in this study. The diagnosis of OSAS was made clinically in all cases. The authors have illustrated the need for paediatric intensive care unit in medically complex children, especially in cases of Praeder-Willi syndromes, trisomy 21 and those on long-term oxygen therapy. Children weighing less than 12kg had more serious complications. The methods of performing tonsillectomy, namely cold steel, coblation and bipolar dissection, did not matter but intracapsular dissection is encouraged. A significant aspect of this study is that a third of these children underwent microlaryngoscopy-bronchoscopy under the same anaesthesia. The incidence of airway abnormalities picked up was 38%, these mainly being laryngomalacia and tracheomalacia. Useful discussion is presented as to where these children should be treated. The consensus appears to be that children aged less than a year and weighing less than 10kg, or those with significant comorbities, should be referred to a tertiary paediatric centre.

Tonsil surgery in children under two years of age.
Madej O, Kubba H.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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