Abstract：
OBJECTIVE: This study presents a novel classification of the anatomical subsites of the tonsillar fossa and discusses their associations with post-tonsillectomy hemorrhage (PTH) after extracapsular tonsillectomy.
METHODS: Coblation tonsillectomy was performed on three adult cadavers and the anatomical subsites of the tonsillar fossa based on the distribution of the tonsillar feeding artery: the upper pole (subsite A), most of the tonsil body (subsite B), the inferior tonsil body (subsite C), and components of the lower pole (subsites D and E). Extracapsular tonsillectomy was prospectively performed using various surgical techniques and PTH was evaluated.
RESULTS: A cadaveric study revealed that the intra- and extra-capsular vessel topographies were essentially identical. Although the demarcation lines varied either up or down by a few millimeters, the arterial vascular network was particularly dense at subsites D and E, and the vessel diameter at these subsites was significantly greater than at subsite C and also (especially) at subsite E. Of 680 patients who underwent tonsillectomy, PTH developed early in 13 (31.7%) and late in 28 (68.3%). Surgical interventions were required by 29/41 patients (70.7%). Subsites D and E were the most common subsites of late PTH and PTH that required intervention. Such intervention was rarely necessary when PTH developed at subsite A or B.
CONCLUSIONS: The new classification of the anatomical subsites of the tonsillar fossa aids inexperienced surgeons and provides an anatomical rationale for variation in surgical technique that minimizes vascular injury, thus improving safety.
METHODS: Coblation tonsillectomy was performed on three adult cadavers and the anatomical subsites of the tonsillar fossa based on the distribution of the tonsillar feeding artery: the upper pole (subsite A), most of the tonsil body (subsite B), the inferior tonsil body (subsite C), and components of the lower pole (subsites D and E). Extracapsular tonsillectomy was prospectively performed using various surgical techniques and PTH was evaluated.
RESULTS: A cadaveric study revealed that the intra- and extra-capsular vessel topographies were essentially identical. Although the demarcation lines varied either up or down by a few millimeters, the arterial vascular network was particularly dense at subsites D and E, and the vessel diameter at these subsites was significantly greater than at subsite C and also (especially) at subsite E. Of 680 patients who underwent tonsillectomy, PTH developed early in 13 (31.7%) and late in 28 (68.3%). Surgical interventions were required by 29/41 patients (70.7%). Subsites D and E were the most common subsites of late PTH and PTH that required intervention. Such intervention was rarely necessary when PTH developed at subsite A or B.
CONCLUSIONS: The new classification of the anatomical subsites of the tonsillar fossa aids inexperienced surgeons and provides an anatomical rationale for variation in surgical technique that minimizes vascular injury, thus improving safety.
摘要：
目的：本研究对扁桃体窝的解剖亚部位进行了新的分类，并讨论了它们与扁桃体囊外切除术后扁桃体切除术后出血（PTH）的关系。
方法：根据扁桃体供血动脉的分布，对三个成年尸体和扁桃体窝的解剖亚部位进行了扁桃体切除术：上极（亚部位A），扁桃体的大部分（子部位B），下扁桃体（亚部位C），和下极点的分量(子点D和E)。使用各种手术技术前瞻性地进行扁桃体囊外切除术，并评估PTH。
结果：一项尸体研究显示，囊内和囊外血管的形貌基本相同。尽管分界线向上或向下变化了几毫米，亚站点D和E的动脉血管网络特别密集，这些亚部位的血管直径明显大于亚部位C和（尤其是）亚部位E。在680例接受扁桃体切除术的患者中，PTH在13个早期（31.7％）和28个晚期（68.3％）发展。29/41例患者需要手术干预（70.7%）。亚位点D和E是晚期PTH和需要干预的PTH的最常见亚位点。当PTH在亚部位A或B发生时，这种干预很少必要。
结论：扁桃体窝解剖亚部位的新分类有助于缺乏经验的外科医生，并为外科技术的变化提供了解剖学原理，可最大程度地减少血管损伤，从而提高安全性。
方法：根据扁桃体供血动脉的分布，对三个成年尸体和扁桃体窝的解剖亚部位进行了扁桃体切除术：上极（亚部位A），扁桃体的大部分（子部位B），下扁桃体（亚部位C），和下极点的分量(子点D和E)。使用各种手术技术前瞻性地进行扁桃体囊外切除术，并评估PTH。
结果：一项尸体研究显示，囊内和囊外血管的形貌基本相同。尽管分界线向上或向下变化了几毫米，亚站点D和E的动脉血管网络特别密集，这些亚部位的血管直径明显大于亚部位C和（尤其是）亚部位E。在680例接受扁桃体切除术的患者中，PTH在13个早期（31.7％）和28个晚期（68.3％）发展。29/41例患者需要手术干预（70.7%）。亚位点D和E是晚期PTH和需要干预的PTH的最常见亚位点。当PTH在亚部位A或B发生时，这种干预很少必要。
结论：扁桃体窝解剖亚部位的新分类有助于缺乏经验的外科医生，并为外科技术的变化提供了解剖学原理，可最大程度地减少血管损伤，从而提高安全性。
