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Clinical Challenges in Otolaryngology
October 2005

No Convincing Premise for Efficacy of Prophylactic Adenotonsillar Ablation

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Arch Otolaryngol Head Neck Surg. 2005;131(10):918. doi:10.1001/archotol.131.10.918

Clark addresses a highly controversial topic and sheds a fair and even light on this debate. It seems likely that adenoidal and possibly tonsillar airway obstruction can cause dentofacial deformity via jaw posturing or some other mechanism. However, the premise that surgical intervention in either or both areas will ameliorate existing or future dentofacial deformity requires a greater leap of faith. Performing adenotonsillar ablation on an otherwise asymptomatic patient purely to minimize or prevent a dentofacial deformity must be approached with caution and healthy skepticism. The otolaryngologist may be caught between the partially enlightened parents’ enthusiasm as to the purported benefits of such surgery and a managed care payor that reasonably requests evidence-based justification. The literature is intriguing but falls well short of convincing. A long-term prospective twin study, which would be necessary to evaluate the efficacy of prophylactic tonsillar airway surgery, would be not only unwieldy but also probably unethical. The otolaryngologist who receives a referral from an orthodontist for prophylactic airway surgery must justify such procedures within his or her own framework of reference and must individualize the care of each patient.

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