Tonsillectomy is the surgical removal of the tonsils. These structures are part of the local immune system and help protect the body from viruses, bacteria, and other pathogens. Frequent infectious diseases can provoke chronic inflammation of the tonsils (tonsillitis). Tonsillectomy surgery is the most effective treatment for children in whom conservative methods have not produced the desired result.
Indications for tonsillectomy
The procedure for removing the tonsils is recommended for children in case of detection of:
- frequent relapses of tonsillitis – more than 5–7 exacerbations over 2 years;
- attacks of sleep apnea;
- purulent complications with each inflammation of the tonsils;
- impaired swallowing function;
- the risk of developing secondary complications – kidney, liver, and heart failure, rheumatism;
- difficulty breathing;
- decompensated form of pathology.
In some cases, doctors perform partial rather than complete removal of the tonsils – tonsillotomy.
Contraindications
Contraindications to the procedure are divided into absolute and relative (temporary). Absolute contraindications include:
- severe hematopoietic diseases;
- diabetes mellitus;
- severe mental and psychoneurological disorders;
- active pulmonary tuberculosis;
- severe renal, hepatic, and cardiac failure.
- Conditions that may require a temporary postponement of tonsillectomy include:
- acute infectious diseases accompanied by fever and general intoxication;
- caries, stomatitis, which increase the risk of infection during surgery;
- skin rashes of various origins – dermatitis, herpes, exacerbation of atopic dermatitis.
The list of possible contraindications may also include other conditions. Everything depends on the age and health of the individual patient, which the doctor fully evaluates before planning the surgery.
Preoperative preparation for tonsil removal
- general clinical blood test with detailed leukocyte formula;
- biochemical blood test;
- coagulation test, blood group, and Rh factor;
- ECG;
- chest x-ray.
The child is required to be examined:
- cardiologist;
- anesthesiologist-resuscitator;
- pediatrician.
Measures are necessary to ensure that the intervention is as effective and safe as possible for the little patient.
Tonsillectomy methods
Depending on the size of the tonsils, the characteristics of the disease, and the anatomy of the nasopharynx of the small patient, different methods of tonsillectomy are used.
Radiowave tonsillectomy
Radiowave tonsillectomy is a surgical procedure performed by otolaryngologists (ENT doctors) based on strict indications based on a diagnosis of chronic decompensated tonsillitis.
Electrocoagulation
This method involves excising the affected tissue using an electric current. It’s completely bloodless and very fast, but carries a relatively high risk of damaging surrounding healthy tissue due to heating.
Ultrasonic excision
Removal of enlarged tonsils is performed using a special ultrasonic scalpel. This method is minimally invasive, but there is a risk of minor bleeding.
Radiofrequency ablation
This treatment method is most often indicated for small tissue growths, as radio waves are unable to remove large lesions. This method is also used for partial tonsil removal.
Vaporization
Tissue excision is performed using a carbon laser. This method is fast, has minimal impact on surrounding healthy tissue, and reduces post-procedure recovery time.
Cryodestruction
This involves freezing the damaged areas with liquid nitrogen. This method is specific and requires long-term therapy and repeated procedures, but this type of tonsillectomy eliminates the risk of bleeding. Cryodestruction is recommended for children with an increased risk of bleeding, such as those with hemophilia or severe endocrine disorders.
Classic tonsillectomy
This remains one of the most popular methods for removing the tonsils. It involves excising the inflamed areas using a scalpel and other instruments. During the procedure, the surgeon also opens up any foci of infection and cleans them of purulent contents.
The duration of the procedure depends on the chosen surgical technique and ranges from 60 minutes to 1.5 hours. After the tonsillectomy, the child remains under medical observation for 24 to 48 hours to monitor their well-being and prevent complications.
Possible consequences of surgery for children
The risk of adverse events following tonsillectomy is minimal, especially if the procedure is performed in a specialized clinic. In rare cases, complications following tonsillectomy include:
- discomfort when swallowing;
- minor bleeding;
- damage to surrounding tissues during thermal excision methods;
- pain for the first time after surgery.
Most of these symptoms resolve spontaneously as the tissues heal. If the wounds have healed but discomfort and pain persist, further diagnostic testing is performed.
The most dangerous complication is considered to be bleeding.
- In case of minor bleeding from small vessels, it is sufficient to treat the surface with antiseptics.
- In more serious cases, the vessel that is the source of bleeding is identified, a clamp is applied, and the bleeding tissue is stitched.
- In cases of severe bleeding, a tamponade is used: a gauze pad is inserted into the oral cavity and pressed against the palate with firm pressure. After 3-5 seconds, the pad is removed to identify the source of the bleeding, and then it is stopped with a clamp and stitches. The patient is also given medications to accelerate blood clotting.
To prevent infection, a course of antibiotic therapy is prescribed before and after the intervention.
Recovery period after tonsil removal
Full recovery occurs 2-3 weeks after surgery. During this time, the child and their parents must adhere to certain measures to help prevent the development of new infections and palate injuries.
- In the first 6-8 hours after tonsil removal, the child should not be given food or drink.
- For the next 3-6 days, the child’s diet should consist of soft, pureed foods that are easy to chew and swallow.
- Babies should not be given sour, very sweet, excessively hot, or salty foods.
- Cold drinks, foods, and ice cream can only be offered if children have had contact with cold foods before surgery without any consequences.
- Take the medications prescribed by your doctor every day.
- Limit communication with other children, strangers, and distant relatives during the rehabilitation period.
- Avoid visiting crowded places, swimming pools, baths, and bodies of water to reduce the risk of re-infection.
If there are no complications and children feel well after tonsillectomy, they can resume their normal daily routine. It’s advisable to limit physical activity slightly during the first week of recovery and carefully monitor them to ensure they don’t injure their palate with foreign objects. Regular follow-up visits at a Consultant ENT private clinic help ensure proper healing, early detection of any issues, and a smooth recovery process.
