Generality
Tonsillectomy is the surgical removal of the palatine tonsils. It is necessary when the tonsils are affected by continuous infections and inflammations, or by rare diseases.
The operation almost always takes place under general anesthesia and can cause pain or bleeding episodes; however, these side effects, unless they are particularly intense, should not cause alarmism, as they are to be considered normal. The first signs of recovery are observed. two weeks after tonsillectomy. During this period, it is good to be followed by a family member and diligently follow the doctor's advice.
What is tonsillectomy?
Tonsillectomy is the surgical removal of the palatine tonsils (which in common parlance are simply called tonsils). The operation is recommended when the tonsils are permanently inflamed and enlarged, or when they are affected by particular pathologies. Traditionally performed under general anesthesia, the operation is practiced above all in individuals with frequent tonsillitis.
PALATINE TONSILS
The palatine tonsils - which are commonly referred to by the single term (albeit imprecise) of tonsils - are two symmetrical lymphoglandular organs, with an anti-infective and immune function. Located at the bottom of the oral cavity (in a position known as the isthmus of the jaw), they have the task of defending the organism from bacterial and viral infections typical of the buccal and nasal cavities.
The average size of the palatine tonsils are:
- Height: 20-25mm
- Length: about 15mm
- Thickness: about 10mm
In addition to the palatine tonsils, there are also the pharyngeal (or adenoid) tonsil and the lingual tonsil; these, unlike the palatine tonsils, are not visible to the naked eye.
Virus:
- Adenovirus
- Rhinovirus
- Epstein Barr virus
- HIV
Bacteria:
- Streptococcus pyogenes
- Group A hemophilic β streptococcus
When you practice
The circumstances that require the execution of a tonsillectomy are generally two:
- Chronic and aggravated tonsillitis (most common situation)
- Large tonsils by nature or with rare diseases.
CHRONIC AND AGGRAVATED TONSILLITES
The term tonsillitis indicates inflammation of the palatine tonsils; this inflammation is often due to viruses and bacteria that penetrate the oral cavity and infect it.
Tonsillectomy surgery is reserved for cases of chronic and / or aggravated tonsillitis.
Tonsillitis that occurs with such frequency is considered chronic:
- More than seven episodes a year
- More than five episodes a year, for two consecutive years
- More than three episodes a year, for three consecutive years
On the other hand, tonsillitis is aggravated in which, due to a "pathogenic infection, the tonsils are very swollen or enlarged.
The conditions that make the intervention necessary are created when antibiotic treatments are ineffective, when there is a severe peritonsillar abscess or when the patient clearly has difficulty breathing (especially during the night) and swallowing.
Tonsillitis are very frequent among children and adolescents, consequently the related tonsillectomy surgery is generally performed on individuals between 3 and 14 years of age.
TONSILS AFFECTED BY RARE PATHOLOGIES
Although more rarely, tonsillectomy surgery may also be necessary in the following situations:
- Individuals with very large tonsils, which hinder normal breathing (particularly night breathing) and swallowing
- Throat tumors, which also affect the tonsils
- Frequent bleeding of the blood vessels supplying the tonsils
Patients, in these cases, can be of very different ages: both young and very old people.
Risks
Like any surgery, tonsillectomy is not entirely free from risks and side effects. The possible drawbacks of the traditional operation are at least five: bad response to anesthetics, bleeding during surgery, post-surgery bleeding, onset of infections and swelling of the tongue.
Bad response to anesthetics
In some situations, the drugs used for general anesthesia can cause mild ailments, such as headaches, nausea, vomiting and muscle cramps.
In other situations, much rarer than the previous ones, anesthetics, combined with the effects of surgery, can also cause the patient's death.
Post-surgery bleeding
It is a relatively common episode after tonsillectomy. It affects about 1-3 out of 100 operated children and about 1 out of 30 operated adults. The bleeding area is that corresponding to the tonsil, so the patient can immediately notice it. In these cases, it is good to gargle with cold water, to narrow the blood vessels. If the bleeding is consistent, however, it is advisable to immediately contact your doctor. Serious bleeding, in fact, requires a second corrective intervention .
Bleeding during surgery
It is a rare situation, which, if it should occur, must be treated with a specific therapeutic intervention and with a hospital stay longer than the traditional one.
Infections
These are rare but possible events, due to the fact that after the surgery the patient is more debilitated than a healthy individual, therefore also more exposed to pathogens. Furthermore, the operated area, especially in the first days, can represent a way of access. to the organism for viruses and bacteria. An emblematic sign of infection is a high fever.
Swelling
After tonsillectomy, it is very common for the tongue and palate to swell and be painful, thus making it difficult to breathe and swallow. The swelling lasts for a few hours and shouldn't be alarming.
Preparation
Once the intervention has been planned, the patient (or his family, if the patient is a child) will receive from his doctor all the useful information and instructions to follow so that the intervention is successful.
Among the various basic instructions, there is also a questionnaire to be filled in which requests:
- All the pharmacological preparations taken by the patient in the last few weeks, whether it is medicines, medicinal herbs or pills. This data is important, because the anesthetic could react, in a very dangerous way, with one of the active ingredients of the aforementioned drugs.
- All allergic reactions to drugs, especially anesthetic ones, which have seen the patient as the protagonist. In some cases, if certain preparations have never been taken, it may be useful to look at family history, to see if any family member has reported allergies or negative reactions of various kinds in the past.
- Predisposition to bleeding. Diseases that alter the clotting process, such as haemophilia for example, can cause copious and uncontrolled blood loss during surgery.
The patient is invited by the doctor to ask him all the questions and doubts relating to the operation that put him in apprehension. The questions regarding the foods to be taken before and after the operation, the length of hospitalization, the arrival are very common. to the hospital on the day of the operation, the drugs allowed before the operation, etc.
DAY OF THE INTERVENTION
On the day of surgery, starting from midnight, the patient is recommended to abstin from food and drink, as there is a risk that problems may arise at the time of general anesthesia.
Once in the hospital, then, the individual to be operated on is subjected to the classic checks of pressure, heartbeat and body temperature, to ensure that there is the basis for proceeding with the tonsillectomy.
Traditional procedure
Once the general anesthesia has been performed, the tonsillectomy operation can be carried out in various ways, all equally safe and effective; the choice of how to proceed is up to the surgeon, who may have preferences or be particularly experienced in a particular method.
MEDICAL STAFF
If the removal of the tonsils is the responsibility of a specialized surgeon, who is in charge of preparing the tonsillectomy?
Blood pressure, body temperature and heart rate checks are usually performed by the nurses on duty.
Anesthesia, on the other hand, is the responsibility of an anesthetist.
GENERAL ANESTHESIA
When it is said that a patient is placed under general anesthesia, it means that he is unconscious at the time of the operation. Therefore, he does not feel pain, except upon awakening and at the end of the operation.
Anesthetic drugs and painkillers are administered in different ways: intravenously, through a cannula inserted in the arm or hand; by inhalation, using a breathing mask or tube; or, finally, both ways.
For the entire duration of the tonsillectomy, the patient, in addition to continuously receiving anesthetic, is also "intubated" (not always, but very often), in order to allow him to breathe correctly and regularly. Intubation is performed by inserting a tube into the mouth and almost up to the trachea.
At the end of the intervention, the anesthetist interrupts the drug administration until the patient regains consciousness.
INTERVENTION METHODS
Tonsillectomy can be performed in at least 5 different ways:
- Classical surgical removal ("cold" removal). It is the typical intervention performed with a steel scalpel, through which the tonsils are dissected, tied to the base and removed. Since the risk of bleeding is more than concrete, the surgeon resorts to anti-haemorrhagic substances or diathermy (see point 2), to close the blood vessels and thus block the output of blood from these. It is the most practiced method.
- Diathermy. Particular form of thermotherapy, it is performed with a probe crossed by current (or an electrode); this, in contact with the tonsils, generates heat to the point of "burning" the lymphoglandular organs themselves. The advantage of this method consists in the fact that the bleeding is severely limited (for this reason, it is also adopted in classical surgical removal).
- Coblation (or cold ablation). The mechanism is similar to that of diathermy, except that the temperatures reached are lower (between 40 and 60 ° C). The destruction of the lymphoglandular tissue of the tonsils occurs at the molecular level, without causing hemorrhagic trauma or considerable irritation.
- Laser. The tonsils are hit with high-energy rays. The risk associated with post-operative bleeding is modest.
- Ultrasound. The tonsils are removed thanks to the so-called ultrasound scalpels, that is tools that, in contact with the lymphoglandular tissue, cause high frequency vibrations. Also in this case, as with the laser, the risk of bleeding is reduced.
Some alternative techniques to traditional surgery - such as CO2 laser ablation or radiofrequency ablation (where heat is generated by electromagnetic radiation) - can be performed under local anesthesia without hospitalization; clearly this option can be evaluated only in the adult and in the collaborating adolescent.
Figure: the instruments for coblation, or cold ablation. From the site: www.arthrocareent.com
Figure: “cold” surgical removal of the tonsils. From the site: www.healthtopics.hcf.com.au
DURATION OF THE INTERVENTION
Without counting the times for anesthesia, tonsillectomy has a variable duration: from 20 minutes to about one hour.
RESIGNATION AND POST-OPERATIVE HEALTH
Discharge, if the operation was carried out without complications, can take place the same day or the morning following the operation. In fact, tonsillectomy is now considered an outpatient operation, whose observation period can be limited to 4 - 8 hours post-surgery.
Upon awakening from anesthesia, the patient is offered to drink and to eat: among the drinks, it is better to avoid acidic drinks (for example, fruit juices), while, among the foods, light, non-solid and easily swallowed.
It is normal to feel pain not only in the mouth but also in the entire jaw, neck and ears: for this reason, the patient or family members will be shown how to take painkillers.
In the first few days after surgery, it is likely that it will be difficult to sleep, especially if the patient is a child.
However, with the support of family members, the post-operative course and complete recovery will be easier.
Recovery methods and times
Ache
The pain subsides within a week, but the first noticeable improvements are observed at the end of the second.
Hygiene
Especially at the beginning, hygiene is fundamental, since the operated individual is weaker and more exposed than people in full health to bacterial or viral infections. It is therefore advisable to avoid crowded environments (for example a school for a child) for at least a couple of weeks and thoroughly wash your mouth and teeth with mouthwash after each meal.
Diet
Although chewing and swallowing are difficult, it is good to gradually get used to eating solid foods again. As noted above, acidic drinks, alcohol and spicy foods are to be avoided.
Hemorrhages
In the first days after surgery, small bleeding from the mouth is normal. It may be useful, to stop them, to gargle with cold water, as the cold has a vasoconstrictive effect. It is recommended not to take aspirin and derivatives, such as pain relievers, as they act against blood clotting (and promote bleeding).
Rest
For at least two weeks, rest and avoid medium-heavy physical activities, such as running or cycling. The doctor recommends a gradual return to everyday life, which was held before the tonsillectomy.
