An Approach to Reduce Uvula Edema After Tonsillectomy
An Approach to Reduce Uvula Edema After Tonsillectomy
A prospective randomized clinical trial that included thirty subjects who underwent
 tonsillectomy. The patients in Group 1 (n:15) were injected with dexamethasone (1 ml, 8 mg)
 through the uvula and soft palate tissue directly before tonsillectomy. Group 2 (n:15)
 patients had tonsillectomy without dexamethasone injection. Patients were examined
 preoperatively and postoperative on the first and fifth days. In this study investigators
 tried an approach of dexamethasone application to reduce uvula edema after tonsillectomy.
Thirty patients between the ages of 18 and 48 years were enrolled in this prospective
 randomized clinical trial from July 2015 to July 2016. The study was carried out in a
 tertiary referral center in Istanbul, Turkey. Permission for the study was obtained from
 Bezmialem Vakif University Clinical Research Ethics Committee, on 03 June 2015, number11/18.

 The patients in Group 1 (n:15) were injected with dexamethasone (1 ml, 8 mg) through the
 uvula and soft palate tissue directly at three points (three points on the connection of the
 uvula, and palatum molle) before tonsillectomy. Group 2 (n:15) patients had tonsillectomy
 without dexamethasone injection. All patients had the operation under general anesthesia by
 utilizing the same protocol. Both of the groups were not given iv/im dexamethasone
 perioperatively. The surgical technique for tonsillectomy was bipolar cautery dissection
 performed by the same surgeon. The oropharyngeal area was examined and photographed
 endoscopically preoperatively and postoperative on the first and fifth days. All of the
 participants were examined with an 8mm diameter 70º endoscope. The photographs of the
 oropharynx (anterior plicas, tonsils, uvula, posterior oropharynx) were taken by holding the
 endoscope positioned vertically to the mouth. Blinded observers made examinations of the
 groups at the postoperative first and fifth days and evaluated the uvula edema by using the
 uvula edema scale that the investigators developed.

 The investigators used a scale for grading uvula edema. There is no such scale in the English
 literature so the investigators developed a scale for grading uvula edema. The investigators
 grade edema from 1 to 5 as an increase of the edema area. It is called Grade 1 if there was
 elongation only at the tip of the uvula. If there was edema in the body and base of the
 uvula, it is called Grade 2. If the uvula edema was spread over a larger area than Grade 2,
 and if there was involvement in the unilateral plica, it is called Grade 3. If it was spread
 to both pharyngeal plicas, it is called grade 4. If the uvula edema caused the complete
 blockage of the posterior pharyngeal tract, it is called Grade 5.

 The statistical tests were conducted using the Statistical Package for the Social Sciences
 version 24.0 for Windows (SPSS Inc., Chicago, Illinois, USA). All quantitative variables were
 estimated using measures of central location (i.e., mean and median) and measures of
 dispersion (i.e., standard deviation [SD]). Data normality was tested using the Shapiro-Wilk
 tests of normality. Descriptive statistical analysis were made. Paired t test was used for
 comparison of intra-group quantitative data. Independent t test was used to compare groups of
 quantitative data.
Inclusion Criteria:

 -  Subjects with recurrent tonsillitis but no sleep apnea

 -  Subjects older than eighteen years old

 -  Subjects were planned to have only tonsillectomy procedure

 Exclusion Criteria:

 -  Subjects who must have additional procedures other than tonsillectomy

 -  Subjects younger than eighteen years old

 -  Subjects that had intravenous dexamethasone administration perioperatively