Brünings Tonsil Knife — Cold Capsular Dissection

Brünings Tonsil Knife — Cold Capsular Dissection

The Brünings tonsil knife is the cold-knife instrument for capsular-plane tonsillectomy in the centre that has chosen cold dissection over bipolar diathermy or coblation. Cold dissection — using a knife and scissors in the peritonsillar plane between the tonsillar capsule and the superior constrictor muscle — has the lowest post-operative pain score and the fastest return-to-diet time of any tonsillectomy technique in randomised data; its disadvantage is the longer intra-operative bleeding that requires patient haemostatic technique.

The cold-knife sequence

Tonsil grasped with Allis or tonsil-grasping forceps → upper pole identified at the soft-palate insertion → Brünings knife enters the peritonsillar plane at the upper pole → blade follows the capsular plane downward to the lower pole → tonsil delivered → bleeding points ligated or diathermied. Throughout the dissection the knife stays on the capsule; deviation into the superior constrictor causes the bleed that the technique is built to avoid.

Why this knife

The Brünings blade angle is set for the natural angle the operator’s hand takes during the upper-pole entry — this is the detail that distinguishes the Brünings from the Freer tonsil knife.