From Tonsil Capping to Tonsillectomy to Tonsillotomy

Medicine has been dealing with palatine tonsil disorders since its beginnings. With the initial aim of eliminating chronic centres of inflammation, over time manifold surgical processes to extract tonsils were developed and tested. Very early on it already became clear that the complete extraction of the tonsil along its connective tissue capsule can lead to serious complications: the risk of bleeding after a tonsillectomy is well-known to currently practising surgeons. In order to reduce this risk and due to not yet existing safe anaesthesia, various techniques were developed aimed at merely reducing the size of the tonsils that is partially removing them within their capsules. Since only smaller intratonsillar blood vessels were affected in this process and bigger peritonsillar feeding arteries and veins remained unharmed, the risk of secondary haemorrhage was reduced considerably. The subtlest instruments for this process were created primarily during the 19(th) century. This intracapsular, partial tonsillectomy, also referred to as tonsillotomy or "tonsil capping", became widespread during that time. Due to its fast and easy application, as well as the low complication rates, it was used especially for children. However, the development of safer anaesthetic techniques at the beginning of the 20(th) century meant that the extraction of the entire tonsil, tonsillectomy in toto, eventually became more feasible even in children. Against this background as well as a result of intense discussions on possible secondary scarring of the remaining tonsil tissue accompanied by inflammatory after-effects, the technique of tonsillotomy, the partial extraction of the tonsils, was gradually abandoned in favour of that of tonsillectomy and eventually almost completely forgotten during the latter half of the 20(th) century. The advances in sleep research and the discovery of general developmental physiological impairment arising from disrupted sleep patterns during infancy led to a rebirth of this surgical application. Tonsillotomy is currently widely accepted as a safe and effective method of treatment for obstructive sleep-related breathing disorders in children. However, due to the history of this procedure, the problem of possible long-term inflammatory complications remains. In the following chapters, first, an abstract of the history of the tonsillotomy is presented. Several historic papers on inflammatory secondary disorders in large patient collectives will be introduced based on a search of the existing literature. Despite the correct diagnostic evaluation as well as the limitation to children unfavourable clinical experiences following a tonsillotomy could not be confirmed even then. The development of tonsillotomy to full tonsillectomy procedures in the 20(th) century will be illustrated by means of these historic sources.