Windfuhr J P, Chen Y-S
Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Plastische Kopf- und Hals-Chirurgie, Kliniken Maria Hilf, Sandradstr. 43, 41061, Mönchengladbach, Deutschland.
HNO-Praxis, Bahnhofstraße 2, 53604, Bad Honnef, Deutschland.
HNO. 2018 Oct;66(10):769-773. doi: 10.1007/s00106-018-0559-5.
Photo documentation of hypertrophic tonsils is requested by some insurance companies to justify reimbursement of tonsillotomy. In 2017, a standardized photo documentation was introduced in tonsillotomy patients to verify the indication and effectiveness of the procedure.
Using the archived photo documentation, this study aimed to evaluate the impact of two different positions of the mouth gag on the oropharyngeal airway.
Pictures were taken through the operating microscope after insertion of the mouth gag but without suspension (D1), after suspension before tonsillotomy (D2), and after resection of tonsillar tissue with the mouth gag under tension (D3). For each picture, a 10-mm scale from a single-use paper ruler was placed on the uvula. For this retrospective study, the patient's images were inserted into PowerPoint slides. Distances were measured with the use of an inserted rectangular grid.
The files of 149 patients undergoing tonsillotomy in a 6-month period were eligible for evaluation. Gender was balanced. The youngest patient was 16 months, the oldest patient 48 years old (mean: 6.95 years; median: 5 years). In all patients, tension of the mouth gag had significantly widened the oropharyngeal diameter (p < 0.001), making the tonsils appear smaller.
Suspension of the mouth gag results in a significant relative "downsizing" of the tonsils due to expansion of the oropharynx. Intraoperative photo documentation should also be performed without suspension of the mouth gag. Further studies may clarify whether stretching of the oropharynx has an impact on the distance between the tonsils and surrounding greater arteries.
一些保险公司要求提供肥大扁桃体的照片记录，以证明扁桃体切除术的报销合理性。2017年，在扁桃体切除术患者中引入了标准化照片记录，以核实该手术的适应症和有效性。
本研究利用存档的照片记录，旨在评估两种不同口咽通气道位置对口咽气道的影响。
在插入口咽通气道但未悬吊时（D1）、扁桃体切除术前悬吊后（D2）以及在口咽通气道处于张力状态下切除扁桃体组织后（D3），通过手术显微镜拍摄照片。对于每张照片，将一次性纸质标尺上的10毫米刻度置于悬雍垂上。对于这项回顾性研究，将患者的图像插入PowerPoint幻灯片中。使用插入的矩形网格测量距离。
在6个月期间接受扁桃体切除术的149例患者的档案符合评估条件。性别均衡。最年轻的患者为16个月，最年长的患者为48岁（平均：6.95岁；中位数：5岁）。在所有患者中，口咽通气道的张力显著扩大了口咽直径（p＜0.001），使扁桃体看起来更小。
由于口咽扩张，口咽通气道的悬吊导致扁桃体明显相对“缩小”。术中照片记录也应在不悬吊口咽通气道的情况下进行。进一步的研究可能会阐明口咽拉伸是否会影响扁桃体与周围较大动脉之间的距离。
