TONSILLECTOMY

TONSILLECTOMY

TONSIL

The tonsils are lymphoid tissues located behind mouth and nose and help to fight infections.The one behind the nose (nasal) is called tonsilla pharyngeal (adenoid), the one on both sides of the throat is called palatine tonsil (tonsil), the one at the base of the tongue is called tonsilla lingualis, and the one around the eustachian tube is called tonsilla tubarius. Apart from these, there are also many small lymphoid tissues in the mouth and throat. These lymphoid tissues meet the viruses and bacteria entering the body ftom the mouth and nose. Over time, they recognize them and produce antibodies against them, allowing our immune system to develop. Especially the tonsils and adenoids grow gradually until the age of 5-6, then begin to shrink and regress to the size of an adult at the age of 11. Especially in frequent infections and allergies, lymphoid tissues grow more than normal and does not decrease. If these tissues, which are normally protective for the body, cannot do their job or become a source of infection, they are recommended to be surgically removed.

Sometimes, even if the tonsil is not inflamed at all, it still needs to be removed if it is very enlarged and causes sleep apnea (intermittent breathing pauses during sleep). Children with tonsil problems generally have a poor appetite and their growth and development are slower than their peers. The age for surgery is generally 3 years and above. However, if it causes sleep apnea, the operation can be performed at a much earlier age, cause the risks of sleep apnea are higher than the risks of surgery. Removal of tonsils and adenoids that cannot do their job does not cause a deficiency in the immune system. In order to make the decision for surgery, the history of the disease and the examination are as important as the process.

In Which Situations Is Tonsil Surgery (Tonsillectomy) Performed?

Exact indications. In the cases below, tonsils should be removed: 

• The tonsils are large enough to obstruct the upper airway, causing severe swallowing difficulties or causing heart-lung complications

• Cause sleep apnea

• Recurrent Peritonsillar abscess (abscess formation around the tonsils)

• Presence of tonsillitis that cause febrile convulsions

• Suspicion of a tonsil-derived tumor

• Tonsil bleeding

Relative indications

Removal of tonsils is strongly recommended with the following conditions:

Recurrent tonsillitis.

> 7 or more times in the last 1 year, 

> 5 or more times per year in the last 2 years,

> 3 or more times a year in the last three or more years

It means that the tonsil cannot protect the body and is a source of infection itself. In this situation it is recommended to remove the tonsil. The important thing here is that the infection attacks are caused by bacteria. It should be well differentiated from viral upper respiratory tract infections. Infection attacks should include a few of the following criteria; Sore throat, fever higher than 38 degrees, large and sensitive lymph nodes in the neck, inflammation accumulation on tonsils, beta (group A beta-hemolytic streptococcus) growth in throat culture.

• PFAPA syndrome 

• Bad taste and bad breath that does not go away despite drug treatment 

• Beta (beta-hemolytic streptococcus) and diphtheria that persists despite drug therapy

• Unilateral tonsil enlargement (tumor suspected) 

• Growth retardation unexplained by other causes 

• Permanent enlargement of lymph nodes in the neck caused by tonsils (longer than 6 months) 

• Speech disorder caused by enlarged tonsils 

• Snoring caused by enlarged tonsils

• Magma, tonsil stones 

• Eagle's syndrome

Besides the indications above, the social criterias that also should be evaluated like a indications of tonsillectomy (tonsil surgery) are the distress of the parents and the loss of work days, the loss of the child's school days and the economic dimension of the infections and treatment.  

What are the Contraindications of Tonsil Surgery ( Tonsillectomy )?

(In which cases tonsil surgery can not be performed?) 

• Bleeding diathesis (blood coagulation disorders) 

• Uncontrollable chronic diseases (such as diabetes, high blood pressure) and risks of anesthesia 

• Anemia 

• Active infection period.

Tonsil surgery cannot be performed before taking these conditions under control. 

Tonsil surgery is the most frequently performed operation in childhood in our country, many European countries, and the USA. The frequency of surgery may vary between countries and different regions of the same country. Allergies are more common in children with chronic tonsillitis. The reverse is also true, that is, chronic tonsillitis is more common in allergic children.

How Is Tonsil Surgery Performed?

Tonsillectomy is performed under general anesthesia. Before the operation, routine blood tests and the evaluation of the anesthesiologist are checked to see if there is an obstacle to the operation. The surgery itself takes about 20-30 minutes. The total time, with the patient sleeping and waking up periods, is approximately 1 hour. Different instruments or methods can be used in surgery such as classical dissection method (cold knife method), Electrocautery (monopolar, bipolar), Radiofrequency, Thermal Welding, Harmonic scalpel, Microdebrider, Laser. Whichever instrument is used, the result is the removal of tonsil tissue.

What is Tonsil Reduction?

In case of excessive growth of tonsils without recurrent tonsillitis, tonsil reduction surgery is performed. For this purpose, instruments such as coblation, harmonic scalpel, radiofrequency, microdebrider are used. Advantages of this procedure are the remaining functioning tonsil tissue, less post-operative pain, and faster recovery. Disadvantages are more frequent post-operative bleeding, recurrent tonsil infections, and the possibility of regrowth of the remaining tonsil tissue.

Postoperative Process and Nutrition

After 5-6 hours of postoperative follow-up, the patient is checked and usually discharged. However; Patients under the age of 3, patients with risk of bleeding, who do not have adequate oral nutrition, who live far from the hospital, who have undergone surgery for sleep apnea or peritonsillar abscess, are hospitalized for at least 1 night.

After the operation, a white-colored cover begins to form in the area of removed tonsils. This cover is actually healing tissue, it should not be mistaken for inflammation. As the tissue under this white cover heals, the whiteness disappears and returns to the normal mucosa color. This process takes an average of 10 days. During this period, especially in swallowing, there may be a sore throat and sometimes pain in the ear complaints. It can mostly be relieved with pain relief syrups.

After the surgery, the feeding starts with cold and soft foods and then is switched to warm and solid foods later. Juicy foods such as cold milk, ice cream, pudding, grainless soup, and fruit juice are recommended for the first 3 days. After the surgery, a diet list is given by the service nurses. You should definitely take plenty of fluids.

Mild fever may occur after surgery. It usually returns to normal with adequate fluid intake and antipyretic.

Children with very large tonsils may experience temporary thinning of the voice after surgery.

Rest for 1 week or 10 days is recommended for students.

What are the Complications of Tonsillectomy?

• Bleeding: Bleeding rate after tonsil surgery is 2-3% and mostly observes in the first 24 hours. Rarely (0.4%) bleeding may happen in 7-10 days. Re-operation may be required for bleeding that cannot be stopped with local interventions.

• Pain 

• Dehydration (fluid loss)

• Weight loss 

• Fever

• Edema and obstruction in the airway

• Local trauma of the intraoral tissues 

• Tongue edema 

• Infection 

• Incomplete removal of tonsil tissue or enlargement of tongue root tonsils 

• Voice changes 

• Jaw joint problems 

• Psychological trauma

• Anesthesia-related complications

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