‘Coffee Bean’ Tonsillotomy

There is no standardized approach in performance of a tonsillotomy , unlike the extracapsular approach. When performing a tonsillotomy on large hypertrophied tonsils, visualizing the posterior pillar—often hidden behind tonsillar tissue—can be challenging, potentially putting this muscular structure at risk for damage and negating the advantages of a tonsillotomy. We desribe a standardized technique for tonsillotomy using a midline split within the tonsillar tissue, creating a “coffee bean” appearance that serves as a pivot point for retraction. This approach allows for more accurate distinction between the posterior tonsil and the pillar, resulting in more precise ablation.​​​​​​​​​​​​​​​​

This approach particularly useful for large hypertrophied tonsils allows for standardization for performance of an intracapsular tonsillectomy and more accurate distinction between the posterior tonsil and the pillar, resulting in more precise ablation.​​​​​​​​​​​​​​​​

Very small tonsils where creating a midline split could risk damaging the tonsil capsule

BONNS ENT RF Plasma Surgical System
Hurd retractor

Standardized tonsillectomy setup with Crowe-Davis mouth retractor

BONSS coblator with an ablate setting of 8, coblate setting of 5

Standard pre-operative workup for a tonsillectomy, if required

Anterior and posterior tonsillar pillars

Tonsil bed with capsule

Superior and inferior poles of the tonsil

Identify damage to tonsil capsule and use of coblate function for hemostasis as necessary

None

Russo E, Festa BM, Costantino A, Bernardocchi A, Spriano G, De Virgilio A. Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis. Laryngoscope. 2024 Apr;134(4):1696-1704. doi: 10.1002/lary.31116. Epub 2023 Oct 16. PMID: 37843298.