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A Potentially Serious Complication

Michael J. Nuara, MD; Albert H. Park, MD; Stephen C. Alder, PhD; Marshall E. Smith, MD; Steve Kelly, MD; Harlan Muntz, MD

Arch Otolaryngol Head Neck Surg. 2008;134(1):10-15.

Objectives  To evaluate an institutional experience with perioral burns after adenotonsillectomy and to survey the national experience of other pediatric otolaryngologists regarding this complication.

Design  A retrospective review of adenotonsillectomy cases from January 1, 1997, to December 31, 2005, was performed to determine the incidence, etiology, severity, and treatment of perioral burns. An online national survey of pediatric otolaryngologists was conducted in May 2006 to identify their experience with perioral burns.

Setting  A tertiary pediatric medical center.

Participants  We evaluated cases with patients younger than 18 years who developed a perioral burn during an adenotonsillectomy or tonsillectomy at Primary Children's Medical Center, Salt Lake City, Utah.

Main Outcome Measures  Institutional and national incidence, number of injuries per physician, technique used, severity of injury, and outcomes. Comparisons were made with respect to respondent experience and techniques used.

Results  Seven cases of perioral burn from a single institution were identified from 4327 procedures, with 1 injury requiring reconstructive surgery. The survey response rate was 101 of 298 invitations (33.9%). Sixty-one respondents reported a total of 124 perioral burns after adenotonsillectomy. Monopolar cautery was the most common technique associated with this injury (n = 84). Coblation was the second most common technique associated with perioral burns and represented 15 (12.1%) of the reported complications. A defective electrocautery device tip was the most commonly identified cause of burn (n = 25), followed by operator error (n = 13), conduction through a metal instrument (n = 8), and lack of insulation in a cautery device (n = 7). Coblation injury was attributed to direct heat transfer from the device shaft. No significant association with operator experience was noted. A total of 14 (11.3%) of the reported injuries were severe, resulting in the need for additional treatment.

Conclusion  Perioral burns are an underreported complication of adenotonsillectomy that can result in severe long-term morbidity.

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery (Drs Nuara, Park, Smith, and Muntz) and Department of Family and Preventive Medicine (Dr Alder), The University of Utah, Bountiful. Dr Kelly is in private practice in Bountiful.