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El-Sisi HE, Etman M, Ebada HA. Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes. Am J Rhinol Allergy 2023; 37:670-678. [PMID: 37408328 DOI: 10.1177/19458924231185727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. OBJECTIVES The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients' symptoms, postoperative bleeding, crusting, and pain scores. METHODS This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group (n = 45), and submucous resection group (n = 45). The outcomes of both techniques were analyzed and compared. RESULTS Both techniques were equally in alleviating patients' symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. CONCLUSION Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting.
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Affiliation(s)
| | - Mohammed Etman
- Otorhinolaryngology, Mansoura University, Mansoura, Egypt
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Wang J, Chen J, Hu B, Zhao L, Li X. A novel classification and grading scale of palatine tonsil anatomy in children. Eur Arch Otorhinolaryngol 2022; 279:5921-5928. [PMID: 35852650 DOI: 10.1007/s00405-022-07515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/14/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The influence of tonsil anatomical differences on post-tonsillectomy hemorrhage and pain has not been studied yet. This study aimed to establish a classification and grading scale of palatine tonsil anatomy, not size, for personalized post-tonsillectomy care. METHODS Between August 2020 and August 2021, 337 children who underwent extracapsular tonsillectomy were recruited. The images of tonsil anatomy during the surgery were recorded and then classified and graded. Postoperative hemorrhage was recorded, and the degree of pain was measured using a visual analog scale (VAS). The primary outcomes were the associations between postoperative hemorrhage, pain, and the classification and grade of tonsil anatomy, analyzed by univariable and multivariable analyses. RESULTS 186 of the 337 patients (55.2%) were male and 151 (44.8%) were female; the mean age was 5.59 years. The overall postoperative hemorrhage rate was 4.1%. The mean postoperative VAS score was 4.96. By univariable analysis with logistic regression model, significant associations were found between postoperative hemorrhage and the grade 2 and grade 3 tonsillar lower pole, and grade 3 tonsillar bed. Multivariable analysis with binary logistic regression model also revealed significant associations between postoperative hemorrhage and the grade 2 and grade 3 lower pole (OR: 8.23, 95% CI 1.01-67.37, P = 0.049; OR: 23.86, 95% CI 2.22-56.47, P = 0.009, respectively) and grade 3 tonsillar bed (OR: 14.25, 95% CI 1.46-18.75, P = 0.022). Linear regression analysis showed the associations between postoperative pain and grade 2 and grade 3 lower pole (β: 0.88, 95% CI 0.31-1.32, P = 0.002; β: 1.56, 95% CI 1.29-3.29, P = 0.001, respectively) and grade 3 anterior surface (β: 0.85, 95% CI 0.30-3.07, P = 0.004). Age and upper pole were not associated with the postoperative hemorrhage and pain neither. CONCLUSION In the present study, we established a novel classification and 3-grade scale of palatine tonsil anatomy, based on upper pole, anterior surface, lower pole, and tonsillar bed. Furthermore, we revealed for the first time that some anatomical characteristics of tonsils were associated with post-tonsillectomy complications.
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Affiliation(s)
- Jing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Jiarui Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Bin Hu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China
| | - Limin Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China.
| | - Xiaoyan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, 200062, People's Republic of China.
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Al-juboori AN, Al Hail A, Emam SS. Congenital bilateral adult choanal atresia: Transnasal endoscopic coblation assisted correction. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Noda M, Shimada MD, Koshu R, Saito C, Ito M. Efficacy of endoscopic powered intracapsular tonsillectomy and adenoidectomy for pediatric obstructive sleep apnea: A retrospective case-control study. Auris Nasus Larynx 2022; 50:383-388. [PMID: 36085267 DOI: 10.1016/j.anl.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Safe surgery for pediatric patients with obstructive sleep apnea (OSA) is important to decrease postoperative events and improve cost-effectiveness. Therefore, this study aimed to compare surgical efficacy and safety between powered intracapsular tonsillectomy and adenoidectomy (PITA) and extracapsular tonsillectomy and adenoidectomy for OSA in children. METHODS In this retrospective case-control study, patient characteristics and postoperative outcomes were compared between 93 children with OSA who underwent PITA and 81 children who underwent conventional extracapsular tonsillectomy and adenoidectomy at a tertiary hospital. Data analysis using multivariate, multiple regression, and binomial logistic regression analyses was performed. RESULTS PITA reduced the odds of postoperative hemorrhage by 8.95% (odds ratio [OR]: 5.69, p = 0.013) and of secondary hemorrhage by 8.8% (OR: 10.08, p = 0.006), decreased postoperative analgesia use by 0.35% (p < 0.001), and increased oral intake on postoperative day 1 by 17% (p < 0.001). There were no significant differences in early hemorrhage or regrowth rates between the groups. CONCLUSION PITA could reduce the risk of secondary hemorrhage and improve postoperative quality of life, which are ideal clinical benefits of surgery in pediatric patients with OSA.
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Affiliation(s)
- Masao Noda
- Department of Otolaryngology and Head and Neck Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan.
| | - Mari Dias Shimada
- Department of Otolaryngology and Head and Neck Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Ryota Koshu
- Department of Otolaryngology and Head and Neck Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Chizu Saito
- Department of Otolaryngology and Head and Neck Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Makoto Ito
- Department of Otolaryngology and Head and Neck Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan
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Extracapsular versus intracapsular tonsillectomy: Outcomes in children with a focus on developmental delay. Int J Pediatr Otorhinolaryngol 2022; 152:110978. [PMID: 34839135 DOI: 10.1016/j.ijporl.2021.110978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Outcomes following intracapsular tonsillectomy (IT) have not been well established in children with developmental delays. The objective of this study was to compare outcomes and complications between intracapsular and extracapsular tonsillectomy (TT) in pediatric patients with developmental delay (DD) in comparison to non-developmentally delayed children. METHODS This is a retrospective study of pediatric patients with DD undergoing tonsillectomy between 2016 and 2019 at a tertiary care hospital. This group included patients with Down Syndrome, Autism Spectrum Disorder, other genetic syndromes, and patients with a diagnosis of global developmental delay. Outcomes and complications were analyzed for IT and TT. RESULTS 2267 charts were reviewed, and 320 patients were identified with DD. Of those, 72 patients underwent IT and 248 underwent TT. In the DD cohort, the IT group had a shorter length of stay (0.97 vs 1.7 days, p < .0001) and was less likely to receive post-operative narcotic medication (2.8% vs 35%, p < .0001) and corticosteroids (9.7% vs 64%, p < .0001) during their hospital stay. Reductions in emergency room (ER) visits (5.6% vs 10%, p = .21) and post-op bleeding (PTH) (1.4% vs 4.8%, p = .31) for IT vs TT were not statistically significant in the DD group. In the NDD group, fewer patients undergoing IT returned to the ER (11% vs 2.3%, p < .0001) or had PTH (4.8% vs 0.25%, p, 0.0001) as compared to those children undergoing TT. There was no difference between parental report of symptom improvement between the groups (39% vs 33%, p = .39). Analysis of 180 patients with preoperative and postoperative sleep study data revealed post-op Apnea Hypopnea Index (AHI) improved with both techniques (74% TT vs 79% IT, p = .7). There were no differences noted for persistent obstructive sleep apnea (OSA) among the two techniques for both study groups (p = .63). CONCLUSION Children with DD undergoing IT have reduced length of stay and reduced inpatient administration of post-operative opioids and steroids. IT has comparable efficacy to TT in treating symptoms of pediatric sleep apnea with a better safety profile. Overall, children undergoing IT return to the operating room less frequently than those undergoing TT. Longer follow-up studies will be needed to evaluate rate of tonsil regrowth, risk of revision surgery and persistence of OSA in these patients.
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Baijal RG, Wyatt KE, Shittu T, Chen EY, Wei EZ, Tan CJ, Lee M, Mehta DK. Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children. Otolaryngol Head Neck Surg 2021; 166:373-381. [PMID: 34058915 DOI: 10.1177/01945998211015176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. STUDY DESIGN The study was a retrospective cohort study. SETTING Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children's Hospital from November 2015 to December 2017. METHODS Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. RESULTS A total of 2437 patients underwent a tonsillectomy at Texas Children's Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. CONCLUSION Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.
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Affiliation(s)
- Rahul G Baijal
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Karla E Wyatt
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Teniola Shittu
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Eric Z Wei
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Maxwell Lee
- Baylor College of Medicine, Houston, Texas, USA
| | - Deepak K Mehta
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Al-Shehri AMS, Alenzi HLS, Ali Mohammed YM, Musleh A, Bharti RK, Saeed Munshet AM. Cauterization tonsillectomy as compared to traditional tonsillectomy technique. J Family Med Prim Care 2020; 9:3981-3985. [PMID: 33110797 PMCID: PMC7586625 DOI: 10.4103/jfmpc.jfmpc_84_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Tonsillectomy is one of the most frequently applied and oldest surgical procedures in otorhinolaryngology. Various surgical techniques are used to perform this operation including traditional and cauterization techniques. Objectives: To assess morbidity and efficacy and compare objectively the techniques in tonsillectomy, i.e., traditional technique and cauterization technique. This study compares the traditional and cauterization tonsillectomy techniques in view of their advantages and complications. Methods: This is a retrospective study and comparative study, conducted during the period from January 2017 to March 2018 from the patients attending to Alnamas General Hospital, Aseer Region, Saudi Arabia. The questionnaire was designed to compare the traditional and cauterization tonsillectomy. Fifty patients underwent traditional technique and fifty patients underwent cauterization method. The data analyzed using SPSS V.16.0 (SPSS Inc; Chicago, IL, USA). Results: A total of 100 patients, 62 males and 38 females, aged 8 to 16 years were included in the study. A total of 100 patients were enrolled in the study. Traditional and cauterization tonsillectomy were performed. 50 (27 male and 23 female) patients, whose ages ranged from 9 to 16 years old underwent the traditional tonsillectomy, 50 (35 male and 15 female) patients whose ages ranged from 8 to 16 years underwent cauterization. The two groups were similar for demographic parameters. The difference between mean operative times of the two methods was statistically significant. Postoperative bleeding is significantly higher in the traditional technique compared to cauterization method. Postoperative pain is significantly less in cauterization method. Only a few patients experienced fever, bleeding, and other complications related to anesthesia. The bleeding severity is significantly lower in the cauterization technique. Postoperative pain was less in cauterization technique on day 1 and day 5. Postoperative pain was from mild to severe. Conclusion: This study revealed significantly less postoperative complications in traditional tonsillectomy in comparison with the cauterization method. Healing time was significantly faster in cauterization technique than in traditional method.
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Affiliation(s)
- Ali Maeed S Al-Shehri
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | | | | | - Abdullah Musleh
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | - Rishi Kumar Bharti
- Family & Community Medicine Department, College of Medicine, King Khalid University, Abha, KSA
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Albright JT, Duncan NO, Smerica AM, Edmonds JL. Intra-capsular complete tonsillectomy, a modification of surgical technique to eliminate delayed post-operative bleeding. Int J Pediatr Otorhinolaryngol 2020; 128:109703. [PMID: 31614242 DOI: 10.1016/j.ijporl.2019.109703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
Pediatric tonsillectomy is a frequently performed procedure using a variety of surgical techniques. Despite decades of modern surgical experience and advances in tools and techniques, a consensus on which technique is superior for minimizing complications has not been established. In a 2014 study, the authors examined differing surgical techniques and devices to determine if there was a significant difference in the bleed rates based on technique and device [1]. In that study 7024 children were evaluated, of which a total of 1.4% (n = 99) of children experienced a postoperative hemorrhage that required a second surgery. There was no significant difference found between the four different techniques that were evaluated. Although the combined rates of post-operative hemorrhage requiring a second surgery was lower compared to many other published reports, we hypothesized that continued improvement in surgical techniques could eliminate post-operative hemorrhage completely. As follow up to that study, we decided on a collective change in technique, and subsequent analysis of our post-operative results with respect to only one outcome, post-operative hemorrhage requiring a second surgery. With a new standardized technique in place, we retrospectively evaluated one year of surgical outcomes. These procedures were performed using the technique of a modified and complete, intra-capsular Coblator tonsillectomy. Of the 783 tonsillectomies done in 12 months, we found there were 0 patients that had experienced a postoperative hemorrhage requiring a second surgery. Based on our previous study with a rate of 1.4% post-operative hemorrhage we would have expected to have 11 episodes of post-operative hemorrhage requiring a second surgery.
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Affiliation(s)
- James T Albright
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Newton O Duncan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Abel M Smerica
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Joseph L Edmonds
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, USA.
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Zhou X, Xu A, Zhen X, Gao K, Cui Z, Yue Z, Han J. Coblation tonsillectomy versus coblation tonsillectomy with ties in adults. J Int Med Res 2019; 47:4734-4742. [PMID: 31456472 PMCID: PMC6833402 DOI: 10.1177/0300060519867822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to compare the intraoperative and postoperative courses of coblation tonsillectomy and coblation tonsillectomy with ties in adults. Methods All patients who underwent tonsillectomy from July 2012 to September 2016 were retrospectively reviewed. Intraoperative and postoperative bleeding, pain, and return to normal food intake were compared between patients who underwent coblation tonsillectomy and those who underwent coblation tonsillectomy with ties. Results Of 515 patients, 300 (58.3%) underwent coblation tonsillectomy and 215 (41.7%) underwent coblation tonsillectomy with ties. Twenty-five (4.9%) patients developed postoperative hemorrhage, 22 (88.0%) of whom had undergone coblation tonsillectomy and 3 (12.0%) of whom had undergone coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy reported less pain than those who underwent coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy with ties resumed a normal diet significantly later than those who underwent coblation tonsillectomy (10.0 ± 3.2 vs. 8.2 ± 1.9 days, respectively). Conclusion Coblation tonsillectomy is associated with less intraoperative bleeding, a shorter surgery time, less postoperative pain, and fewer days to recovery of a normal diet than is coblation tonsillectomy with ties. However, coblation tonsillectomy with ties is associated with remarkably reduced postoperative hemorrhage.
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Affiliation(s)
- Xuanchen Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Anting Xu
- Department of Otorhinolaryngology and Head and Neck Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xiaoyue Zhen
- Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Kun Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhaoyang Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhiyong Yue
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Han
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Blake KV, Hossain J, Chafin B, Black A, Schrum S, Josephson G. Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery. EAR, NOSE & THROAT JOURNAL 2019; 98:E1-E7. [PMID: 30939911 DOI: 10.1177/0145561319838941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This was a randomized controlled trial of low thermal damage device versus traditional electrosurgery in children 3 to 17 years old with a clinical diagnosis of sleep disordered breathing, obstructive sleep apnea with adenotonsillar hypertrophy, or recurrent adenotonsillitis. Pain score (Wong-Baker FACES pain scale) was recorded each morning before eating, drinking, or administering pain medication for 14 days postoperatively. Seventy-five children were enrolled. There was no difference in the rate of decrease in pain scores. A significant interaction between rate of pain decrease and number of pain medication doses was present ( P < .0001). Median number of pain medication doses was greater with electrosurgery (36, range: 7-49) versus low thermal device (21, range: 2-124; P = .001). Pain scores reached 0 after a median of 7 days (95% confidence interval [CI], 5.2-8.6) for low thermal device and 9 days (95% CI, 8.0-10.0) for electrosurgery ( P = .67). One child randomized to electrosurgery was withdrawn due to hospitalization for postoperative bleed. In children, low thermal device results in significantly less pain medication used during the postoperative period than electrosurgery.
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Affiliation(s)
- Kathryn V Blake
- 1 Center for Pharmacogenomics and Translational Research, Nemours Children's Specialty Care, Jacksonville, FL, USA.,2 Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jobayer Hossain
- 3 Bioinformatics Core Facility, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Brett Chafin
- 4 Division of Otolaryngology, Department of Surgery, Nemours Children's Specialty Care, Jacksonville, FL, USA.,5 Department of Otorhinolaryngology, Mayo Medical School, Rochester, MN, USA.,6 Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, FL, USA
| | - Angela Black
- 4 Division of Otolaryngology, Department of Surgery, Nemours Children's Specialty Care, Jacksonville, FL, USA.,5 Department of Otorhinolaryngology, Mayo Medical School, Rochester, MN, USA
| | - Stefanie Schrum
- 5 Department of Otorhinolaryngology, Mayo Medical School, Rochester, MN, USA.,7 Division of Anesthesiology, Department of Surgery, Nemours Children's Specialty Care, Jacksonville, FL, USA
| | - Gary Josephson
- 4 Division of Otolaryngology, Department of Surgery, Nemours Children's Specialty Care, Jacksonville, FL, USA.,5 Department of Otorhinolaryngology, Mayo Medical School, Rochester, MN, USA.,6 Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, FL, USA
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Kim MS, Choi HG, Park EK, Kim SY, Kim JH, Park B. Natural course of tonsillectomy pain: A prospective patient cohort study. Auris Nasus Larynx 2018; 45:508-513. [DOI: 10.1016/j.anl.2017.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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Reusser NM, Bender RW, Agrawal NA, Albright JT, Duncan NO, Edmonds JL. Post-tonsillectomy hemorrhage rates in children compared by surgical technique. EAR, NOSE & THROAT JOURNAL 2018; 96:E7-E11. [PMID: 28719712 DOI: 10.1177/014556131709600702] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite the sheer number of pediatric tonsillectomies performed in the United States annually, there is no clear consensus as to which surgical technique is superior. One way to compare surgical techniques is to study the morbidity associated with each. We report postoperative hemorrhage rates, one of the frequently encountered major adverse events, as part of a retrospective chart review across four different surgical techniques. These surgeries involved either (1) Coblation, (2) Co-blation with partial suture closure of the tonsillar fossa, (3) diathermy, or (4) partial intracapsular tonsillectomy (PIT). Of the 7,024 children we evaluated, 99 (1.4%) experienced a postoperative hemorrhage that required a second surgery; hemorrhage occurred after 33 of the 3,177 Coblation-alone procedures (1.04%), 28 of the 1,633 Coblation with partial suture closure procedures (1.71%), 29 of the 1,850 diathermies (1.57%), and 9 of the 364 PIT procedures (2.47%). Statistical analysis of hemorrhage rates with each surgical technique yielded p values >0.05 in each case (Coblation alone and Coblation with partial suture closure: p = 0.29; diathermy: p = 0.47; PIT, p = 0.20). Based on these data, we conclude that none of these techniques is significantly superior in terms of decreasing the risk of post-tonsillectomy hemorrhage in children. Therefore, surgeons should continue to use the surgical procedure they are most familiar with to optimize recovery in the postoperative period.
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Affiliation(s)
- Nicole M Reusser
- Department of Dermatology The University of Texas Health Science Center at Houston, Houston, TX, USA
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The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques. The Journal of Laryngology & Otology 2017; 132:240-245. [PMID: 29151376 DOI: 10.1017/s0022215117002328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients. METHODS A total of 137 patients, aged 2-50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected. RESULTS Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001). CONCLUSION Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.
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Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017; 8:CD004619. [PMID: 28828761 PMCID: PMC6483696 DOI: 10.1002/14651858.cd004619.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven. OBJECTIVES To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2017, Issue 3); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 April 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) of children and adults undergoing tonsillectomy with coblation compared with any other surgical technique. This review is limited to trials of extracapsular (traditional) tonsillectomy and excludes trials of intracapsular tonsil removal (tonsillotomy). DATA COLLECTION AND ANALYSIS We used the standard Cochrane methods. Our primary outcomes were: patient-reported pain using a validated pain scale at postoperative days 1, 3 and 7; intraoperative blood loss; primary postoperative bleeding (within 24 hours) and secondary postoperative bleeding (more than 24 hours after surgery). Secondary outcomes were: time until resumption of normal diet, time until resumption of normal activity, duration of surgery and adverse effects including blood transfusion and the need for reoperation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included 29 studies, with a total of 2561 participants. All studies had moderate or high risk of bias. Sixteen studies used an adequate randomisation technique, however the inability to mask the surgical teams and/or provide adequate methods to mitigate the risk of bias put nearly all studies at moderate or high risk of detection and measurement bias for intraoperative blood loss, and primary and secondary bleeding. In contrast most studies (20) were at low risk of bias for pain assessment. Most studies did not report data in a manner permitting meta-analysis.Most studies did not clearly report the participant characteristics, surgical indications or whether patients underwent tonsillectomy or adenotonsillectomy. Most studies reported that tonsillitis (infection) and/or tonsillar hypertrophy (obstruction) were the indication for surgery. Seven studies included only adults, 16 studies included only children and six studies included both. Pain At postoperative day 1 there is very low quality evidence that patients in the coblation group had less pain, with a standardised mean difference (SMD) of -0.79 (95% confidence interval (CI) -1.38 to -0.19; 538 participants; six studies). This effect is reduced a SMD of -0.44 (95% CI -0.97 to 0.09; 401 participants; five studies; very low-quality evidence) at day 3, and at day 7 there is low quality evidence of little or no difference in pain (SMD -0.01, 95% CI -0.22 to 0.19; 420 participants; five studies). Although this suggests that pain may be slightly less in the coblation group between days 1 and 3, the clinical significance is unclear. Intraoperative blood loss Methodological differences between studies in the measurement of intraoperative blood loss precluded meta-analysis. Primary and secondary bleeding The risk of primary bleeding was similar (risk ratio (RR) 0.99, 95% CI 0.48 to 2.05; 2055 participants; 25 studies; low-quality evidence). The risk of secondary bleeding was greater in the coblation group with a risk ratio of 1.36 (95% CI 0.95 to 1.95; 2118 participants; 25 studies; low-quality evidence). Using the median of the control group as the baseline risk, the absolute risk in the coblation group was 5% versus 3.6% in the control group. The difference of 1.3% has a 95% CI of 0.2% lower in the coblation group to 3.5% higher. Secondary outcomes Differences in study design and data reporting precluded the identification of differences in the time to resumption of normal diet or activity, or whether there was a difference in the duration of surgery.Although we could not feasibly compare the costs of equipment or operative facility, anaesthetic and surgical fees across different healthcare systems we used duration of surgery as a proxy for cost. Although this outcome was commonly reported in studies, it was not possible to pool the data to determine whether there was a difference.Adverse events other than bleeding were not well reported. It is unclear whether there is a difference in postoperative infections or the need for reoperation. AUTHORS' CONCLUSIONS The coblation technique may cause less pain on postoperative day 1, but the difference is small and may be clinically meaningless. By postoperative day 3, the difference decreases further and by postoperative day 7 there appears to be little or no difference. We found similar rates of primary bleeding but we cannot rule out a small increased risk of secondary bleeding with coblation. The evidence supporting these findings is of low or very low quality, i.e. there is a very high degree of uncertainty about the results. Moreover, for most outcomes data were only available from a few of the 29 included studies.The current evidence is of very low quality, therefore it is uncertain whether or not the coblation technique has any advantages over traditional tonsillectomy techniques. Despite the large number of studies, failure to use standardised or validated outcome measures precludes the ability to pool data across studies. Therefore, well-conducted RCTs using consistent, validated outcome measures are needed to establish whether the coblation technique has a benefit over other methods. In the included studies we identified no clear difference in adverse events. However, given the rarity of these events, randomised trials lack the power to detect a difference. Data from large-scale registries will provide a better estimate of any difference in these rare outcomes.
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Affiliation(s)
- Melissa Pynnonen
- Taubman CenterDepartment of Otolaryngology ‐ Head and Neck Surgery1500 E Medical Center DriveAnn ArborMichiganUSA
| | - Jennifer V Brinkmeier
- Saint Louis University School of MedicineOtolaryngology ‐ Head and Neck Surgery1465 S. Grand BoulevardRoom B‐826Saint LouisMissouriUSA63104
| | - Marc C Thorne
- Taubman CenterDepartment of Otolaryngology ‐ Head and Neck Surgery1500 E Medical Center DriveAnn ArborMichiganUSA
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Experience is more important than technology in paediatric post-tonsillectomy bleeding. The Journal of Laryngology & Otology 2017; 131:S35-S40. [PMID: 28393742 DOI: 10.1017/s0022215117000755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Paediatric tonsillectomy is a common procedure and one of the first skills acquired by surgical trainees. Post-tonsillectomy bleeding is one of the most significant complications. This study examined post-tonsillectomy bleed rates associated with technology and level of surgical experience. METHODS Data were collected on all tonsillectomies performed by surgical consultants (n = 6) and trainees (n = 10) at affiliated hospitals over a nine-month period. Hospital records were audited for post-tonsillectomy bleeding re-admissions and returns to the operating theatre. RESULTS A total of 1396 tonsillectomies were performed (279 by trainees, 1117 by consultant surgeons). Primary post-tonsillectomy bleed rates were equivalent between trainees and consultants. Secondary bleed rates were significantly greater for trainees (10.0 per cent) compared to consultants (3.3 per cent), as were return to operating theatre rates (2.5 per cent vs 0.7 per cent). Amongst consultants, technology used was not associated with differences in secondary post-tonsillectomy bleeding and returns to the operating theatre. CONCLUSION Our data suggest that experience of the surgeon may have greater bearing on post-tonsillectomy bleed rates than the technology used.
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Abstract
Tonsillectomy is a commonly performed procedure with an accepted risk of posttonsillectomy hemorrhage (PTH) approaching 5%, but catastrophic effects of hemorrhage are exceedingly rare. A variety of surgical techniques and hemostatic agents have been used to reduce the rate of hemorrhage, although none eliminate the risk. Numerous patient, surgical, and postoperative care factors have been studied for an association with PTH. The most consistent risk factors for PTH seem to be patient age and coagulopathies. Surgeon skill and surgical technique are most consistently associated with primary PTH.
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Affiliation(s)
- Ryan M Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 256515, Seattle, WA 98195, USA
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE Pacific St, Box 256515, Seattle, WA 98195, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OA.9.329, Seattle, WA 98105, USA.
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Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg 2017; 156:442-455. [PMID: 28094660 PMCID: PMC5639328 DOI: 10.1177/0194599816683915] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 01/21/2023]
Abstract
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
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Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Chris Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Nila Sathe
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Siva Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center
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Pang Y, Gong J, Huang J, He S, Zhou H. Coblation tonsillectomy under surgical microscopy: A retrospective study. J Int Med Res 2016; 44:923-30. [PMID: 27217239 PMCID: PMC5536629 DOI: 10.1177/0300060516628705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/31/2015] [Indexed: 11/16/2022] Open
Abstract
Objective A retrospective study to compare surgical parameters and postoperative pain in patients undergoing coblation tonsillectomy with or without microscopic guidance. Methods Data regarding duration of surgery and hospital stay, intraoperative blood loss, incidence of haemorrhage and postoperative pain scores were retrieved from the medical records of adult patients undergoing coblation tonsillectomy under direct vision or with microscopic guidance. Results The incidence of secondary haemorrhage (>24 h postoperatively) was significantly lower and the duration of hospital stay was significantly shorter in the microscope group (n = 92) than the direct vision group (n = 76). Pain scores both at rest and while swallowing reached ≤3 (no significant impact on quality-of-life) significantly faster in the microscope group than the direct vision group. Conclusions Microscope-assisted coblation tonsillectomy decreases the duration of hospital stay and the incidence of postoperative secondary haemorrhage, and results in an early improvement in postoperative pain scores.
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Affiliation(s)
- Yufeng Pang
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jingrong Gong
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Juan Huang
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Shuangzhu He
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Hong Zhou
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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Al-Mahbashi MY, Saeed SQ, Al-Attab AA, Raja’a YA. Comparison of three techniques for tonsillectomy during free medical camps in Yemen. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2014. [DOI: 10.4103/1012-5574.138479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Duarte VM, Liu YF, Shapiro NL. Coblation total tonsillectomy and adenoidectomy versus coblation partial intracapsular tonsillectomy and adenoidectomy in children. Laryngoscope 2014; 124:1959-64. [DOI: 10.1002/lary.24632] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 01/14/2014] [Accepted: 01/29/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Victor M. Duarte
- Department of Head and Neck Surgery; David E. Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Yuan F. Liu
- Department of Head and Neck Surgery; David E. Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Nina L. Shapiro
- Department of Head and Neck Surgery; David E. Geffen School of Medicine at UCLA; Los Angeles California U.S.A
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Abstract
Adenotonsillectomy (AT) is one of the most common pediatric surgical procedures performed in the United States; more than 530,000 are performed annually in children younger than 15 years of age. AT was traditionally performed for recurrent tonsillitis and its sequelae but in recent times, sleep-disordered breathing/obstructive sleep apnea in children has emerged as the primary indication for surgical removal of adenoids and tonsils. The new guidelines used by clinicians to identify children who are appropriate candidates for AT address indications based primarily on obstructive and infectious causes.
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Affiliation(s)
- Sharon D Ramos
- Department of Otolaryngology, University of Texas-Medical Branch at Galveston, Galveston, TX 77555-0521, USA.
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