Two Techniques of Tonsillectomy Performed in Identical Twins: A Case Report

Document Type: Case Report


1 Department of Otorhinolaryngology, Baqiyatallah University of Medical Sciences, Tehran, Iran.

2 Department of Otorhinolaryngology, Tehran University of Medical Sciences, Tehran, Iran.


Cold dissection (CD) and bipolar cautery dissection (BCD) techniques are two common surgical tonsillectomy procedures used in the clinic. Obstruction has become more prevalent as the major surgical indication and is most prominently observed in younger children.
Case Report:
 In this report, we aimed to explain the abovementioned surgical techniques in detail and compare the results in identical twins (monozygote twins). Using low energy electrocautery, irrigating the operation site continuously during cauterization, avoiding unnecessary sutures, and direct cautery to the tonsil bed are all effective measures that have diminished post-op pain in bipolar electrocautery dissection, compared to cold dissection tonsillectomy.
Bipolar cautery dissection with some modification is very good alternative for tonsillar surgery.


Main Subjects

1. Silveira H, Soares JS, Lima HA. Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol. 2003; 67(4): 345-51.

2. Kirazli T, Bilgen C, Midilli R, Ogüt F, Uyar M, Kedek A. Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol. 2005; 262(9): 716-18.

3. Gates GA, Folbre TW. Indications for adenotonsillectomy. Arch Otolaryngol Head Neck Surg. 1986; 112(5): 501-2.

4. Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13. 1998; 139:1-119.

5. Karatzias GT, Lachanas VA, Sandris VG. Thermal welding versus bipolar tonsillectomy: a comparative study. Otolaryngol Head Neck Surg. 2006; 134(6): 975-8.

6.Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg  E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol. 2000; 52(3): 239-46.

7. Leinbach  RF, Markwell SJ, Colliver  JA, Lin SY. Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg. 2003; 129(4): 360-4.

8. Özkırıs M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol.  2012; 269(5):1497-501.

9. Raut  VV, Bhat N, Sinnathuray  AR, Kinsella JB, Stevenson M,  Toner JG. Bipolar scissors versus cold dissection for pediatric tonsillectomy-a prospective, randomized pilot study. Int J Pediatr Otorhinolaryngol.2002; 64(1): 9-15.

10. Kerschner J E, Conley S F,  Cook S P. Surgical techniques of pediatric tonsillectomy: Is there evidence of better outcomes? Operative Techniques in Otolaryngology-Head and Neck Surgery, 2006; 17(4):262-7.

11. Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-tonsillectomy morbidity and quality of life in pediatric patients with obstructive tonsils and adenoid: microdebrider vs electrocautery. Otolaryngol Head Neck Surg. 2006; 134(1): 114-20.

12. Stoker KE, Don DM, Kang DR, Haupert  MS, Magit A , Madgy DN. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg.  2004; 130(6): 666-75.