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ASOHNS ASM 2025
ASOHNS ASM 2025
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Bilateral vs unilateral tonsillectomy in TORS Oropharyngectomies: Does it affect swallow function?

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Institution: Royal Adelaide Hospital Department of Otolaryngology - South Australia, Australia

AIMS: Resection of the contralateral tonsil in the setting of trans-oral robotic unilateral oropharyngectomy for oropharyngeal cancer is a topic of debate regarding its prognostic benefit and associated morbidity. The impact on post-operative swallow outcomes when including the contralateral tonsil in a resection is to be explored. The study aims to evaluate swallow outcomes in patients undergoing unilateral versus bilateral tonsillectomy in a TORS(Transoral robotic surgery) oropharyngectomy. METHODOLOGY: A retrospective cohort study compared swallowing outcomes between patients who underwent unilateral tonsillectomy and those who underwent bilateral tonsillectomy in a TORS oropharyngectomy. Day of first oral intake post operatively and total number of days requiring nasoenteric feeding were used as clinical markers for swallow function. A normal distribution of both metrics was created and compared between the two samples using an independent t-test. RESULTS: 64 patients who underwent TORS oropharyngectomy between 2013 and 2023 at the Royal Adelaide Hospital were included in the study. Of these, 21 underwent bilateral tonsillectomy and 43 underwent unilateral tonsillectomy. The average post-operative day of first oral intake was 5.75 for unilateral tonsillectomy and 4.25 for those with bilateral tonsillectomy. An independent t-test was performed. The t-score was -1.864 and resultant p value was 0.067. The average duration of enteral feeding was 8.71 days for unilateral tonsillectomy and 8 days for those with bilateral tonsillectomy. An independent t-test was performed yielding a t-value was 0.45 and resultant p value of 0.65. CONCLUSION: There was an earlier average day of first oral intake for those with a bilateral tonsillectomy, and days fed enterically was similar across both samples. It was thus concluded that including the contralateral tonsil in a TORS unilateral oropharyngectomy offers no statistically significant difference in post-operative swallow outcomes.

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Dr Scott Chandrasiri - , Dr Amanthi Mendis - , Dr Raguwinder Sahota - , Dr Andrew Foreman - , A/Prof Suren Krishnan - , A/Prof John-Charles Hodge -