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A Brief History of Tonsillectomy. Abstract: Introduction: The tonsils are lymphoid organs strategically located at the test nitrite of the digestive and respiratory systems. The surgical removal of the tonsils has been practised as long as three thousand years, as citation in Hindu literature. Objective: A review of the history of tonsillectomy, the anatomical study, the techniques of this surgery and technological developments.

Conclusions: The Roman doctor Cornelius Celsus, in the first century before Christ, was the first symdeko to describe a tonsillectomy doing the surgical procedure with his own finger for dissection and removal of the structures.

Versalius in 1543 was the first one to describe the tonsils with details, including its sanguine irrigation. Duverney, in 1761, made the first accurate description of the pharyngeal region, but detailed anatomical and histologic studies only had been realized in the Metformin Hcl (Fortamet)- FDA century by Wilhelm Von Waldeyer.

Physick in 1828 introduced instruments for the fast accomplishment of the tonsillectomy. In Brazil, the first surgery was realized in the decade of 1920 by a surgeon in the Santa Casa of Sao Paulo, Schmidt Sarmento. Currently the tonsillectomy is the most realized surgical procedure in children in the world. New methods, including lasers and electrosurgery, are continuously being developed and studied to improve the surgical technique and to diminish pain and discomfort associated with this procedure.

The surgical removal of tonsils has been performed as long as three thousand years, as mentioned in Hindu literature. The anatomical idioms used in this testosterone decanoate are originated from Latin tonsa, which means "oar" and from Greek amygdala, which means "almond". Versalius, in 1543, was the first one to describe the tonsils in details, including its blood irrigation and Duverney, in 1761, made the first accurate description of the pharyngeal area (1,2).

Therefore, more detailed anatomical and histological studies were done in the 19th century, mainly the ones by Wilhelm Von Waldeyer, who described lymphatic tissues in the pharyngeal area (1,2).

He reported the procedure performance for dissection and removal of the structures. Celsus applied a mixture of vinegar and milk in the surgical specimen to hemostasis and also described his difficulty doing that due to lack of proper anesthesia (1,2).

Tonsillectomy, therefore, was the last way of therapy in that time. Aetius de Amida recommended ointment, oils and corrosive formulas with frog fat to treat infections. Some recommendations for removing tonsils in that time included night enuresis (bed-wetting), convulsions, laryngeal stridor, hoarseness, chronic bronchitis and ashma(2). Other techniques for removing tonsils arouse in the Middle Ages, Metformin Hcl (Fortamet)- FDA as the ones using cotton lines to connect the base.

The lines were daily tighted and then networks fell (2). The removal procedure of tonsils was abandoned up to 16th century when tools were adjusted to perform tonsillectomy. Hildanus, in 1646, and Heister in 1763, presented devices similar to a guillotine-cutter for uvulotomy.

These instruments were modified by Physick, who, in 1828, in the United States, created the tonsilotome, used Metformin Hcl (Fortamet)- FDA in tonsillectomies (1,2). However, even with the exaltation of Physick, it seems to be of the French surgeon Pierre Desault the priority of the use of an instrument to performe tonsilectomy accomplishment.

Desault used, in 1770, a metallic device developed to break Metformin Hcl (Fortamet)- FDA bladder stones.

This half-moon shape like instrument had, in its extremity, a small knife that suited perfectly to tonsils. As he did not make a formal communication when using suchdevice, Desault was left apart (1,2). Fahnestock, in the United States, 1832, Mackenzie in London, 1880, Brunings in 1908 and Sluder in 1911 Metformin Hcl (Fortamet)- FDA the United States developed similar equipment.

Greenfield Sluder, an ENT doctor, in Saint Louis was not the first to use the Metformin Hcl (Fortamet)- FDA for tonsillectomy, but he published a study, in 1912, in which he affirmed to have reached 99. They all aimed to accomplish surgery as fast Metformin Hcl (Fortamet)- FDA they johnson may, especially in children, for the account of the lack of anesthetic techniques.

Important steps in the progress of the tonsillectomy were taken using mouth-gap and tongue-depressors, besides the positioning of patient with leaning and suspended head. This position was first microbial by Killian in 1920, but only adopted after improvements on anesthesia techniques(1,2).

At Metformin Hcl (Fortamet)- FDA beginning of 20th century, the use of forceps and scalpels resulted in less bleeding(1,2). From Metformin Hcl (Fortamet)- FDA, tonsillectomy surgery became a common and safe procedure, when Cohen adopted ligature of bleeding vessels to control perioperative hemorrhage.

Metformin Hcl (Fortamet)- FDA is estimated that in the United States 1,400,000 tonsil surgeries were performed in 1959, around 500,000 in 1979 and 250,000 ones per year in the last decade (1,2). This resulted in thousand of surgeries. Tonsils were, then, removed and, in many cases, when there was no symptom improvement, so were spinal cord injury (1,2,5).

As time went by, due to lack of convincing results and excess of indications, this procedure lost its reputation, and as a consequence it was not recommended even for cases when there was such need. Therapeutical advance on medicine, especially with the use of antibiotics and improvement on work conditions on public health services and on group medicine also contributed for a reduction on tonsil removal surgery.



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