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 pathologies.
The surgery almost always takes place under general anesthesia and can cause pain or bleeding episodes; however, these side effects, unless they are particularly intense, must not cause alarmism, as they are to be considered normal. The first signs of recovery are observed two weeks after the tonsillectomy. During this period, it is good to be followed by a family member and adhere diligently to the doctor's advice.
What is tonsillectomy?
Tonsillectomy is the surgical operation to remove the palatine tonsils (which in the common language are simply called tonsils ). The surgery is recommended when the tonsils are perpetually inflamed and enlarged, or when they are suffering from particular pathologies. Traditionally performed under general anesthesia, the operation is practiced mainly in individuals with frequent tonsillitis.
TONSILLE PALATINE
The palatine tonsils - which are commonly referred to as the sole (albeit imprecise) term 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 jaws), they have the task of defending the organism from bacterial and viral infections typical of the buccal cavity and the nasal cavity.
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.
| Pathogens that trigger tonsillitis | |
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When practicing
The circumstances requiring a tonsillectomy are generally two:
- Chronic and aggravated tonsillitis (most common situation)
- Tonsils large by nature or suffering from rare diseases.
CHRONIC AND AGGRAVATE TONSILLITES
The term tonsillitis indicates inflammation of the palatine tonsils; this immobilization is often due to viruses and bacteria that penetrate the oral cavity and infect it.
Tonsillectomy is reserved for cases of chronic and / or aggravated tonsillitis .
The tonsillitis that appears with this frequency is considered to be chronic :
- More than seven episodes per year
- More than five episodes per year, for two consecutive years
- More than three episodes per year, for three consecutive years
Instead, tonsillitis is aggravated, where the tonsils are very swollen or enlarged due to a pathogenic infection.
The conditions that make intervention necessary are created when antibiotic treatments are ineffective, when there is a severe peritonsillar abscess or when the patient has clear difficulties in breathing (especially during the night) and in swallowing.
Tonsillitis is very frequent among children and adolescents, therefore the relative tonsillectomy is usually performed on individuals between 3 and 14 years old.
TONSIL AFFECTED BY RARE PATHOLOGIES
Even more rarely, tonsillectomy surgery may become necessary even in the following situations:
- Individuals with very large tonsils, which hinder normal breathing (in particular, night breathing) and swallowing
- Throat tumors that also affect the tonsils
- Frequent bleeding of blood vessels supplying the tonsils
In these cases, patients may have very different ages: both young and very old.
risks
Like any surgery, tonsillectomy is not entirely free of risks and side effects. The possible drawbacks of the traditional operation are at least five: bad response to anesthetics, bleeding during surgery, post-operative bleeding, onset of infections and swelling of the tongue.
Bad response to anesthetics
In some situations, the drugs used for general anesthesia can cause minor disorders, such as headaches, nausea, vomiting and muscle cramps.
In other situations, far rarer than the previous ones, anesthetics, combined with the effects of surgery, can also cause patient death.
Post-intervention bleeding
It is a relatively common episode after tonsillectomy. It concerns around 1-3 children operated on 100 and about 1 adult operated on 30. The area of the bleeding is that corresponding to the tonsils, therefore the patient can notice it immediately. If the bleeding is mild and remains stable, you should not be alarmed. In these cases, it is good to gargle with cold water to narrow the blood vessels. If the bleeding is substantial, 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, should be treated with a specific therapeutic intervention and with a longer hospitalization than the traditional one.
Infections
These are rare but possible events, due to the fact that after surgery the patient is more debilitated than a healthy individual, therefore also more exposed to pathogens. Furthermore, the operated area, especially in the early days, can be a gateway to the organism for viruses and bacteria. An emblematic sign of infection is high fever.
Swelling
After tonsillectomy, it is very common for the tongue and the palate to swell and be painful, thus making breathing and swallowing difficult. The swelling lasts for a few hours and should not alarm.
Preparation
Once the intervention is planned, the patient (or his family members, if the patient is a child) will receive all the useful information and instructions to follow from his treating physician in order for the surgery to be successful.
Among the various basic instructions, there is also a questionnaire to be filled in which requires:
- All the pharmacological preparations taken by the patient in recent weeks, whether they are medicines, medicinal herbs or pills. This is important, because the anesthetic could react very dangerously with one of the active ingredients of the aforementioned drugs.
- All allergic reactions to drugs, especially the anesthetic ones, which saw the patient as the protagonist. In some cases, if certain preparations have never been taken, it might be useful to look at family history to see if any family members have reported allergies or adverse reactions of various kinds in the past.
- Predisposition to bleeding. Diseases that alter the coagulation process, such as haemophilia for example, can cause copious and uncontrolled blood loss during the procedure.
The patient is invited by the doctor to ask him all the questions and doubts, concerning the intervention, that put him in apprehension. The questions regarding the foods to be taken before and after the operation, the hospitalization times, the arrival at the hospital on the day of the operation, the medicines allowed before the operation, etc. are very common.
DAY OF INTERVENTION
On the day of the intervention, starting at midnight, abstinence from food and drink is recommended to the patient, as there is a risk that problems may arise at the time of general anesthesia.
Once in the hospital, then, the individual to be treated is subjected to the classic controls of pressure, heart rate and body temperature, to ascertain that there are bases for proceeding with tonsillectomy.
Traditional procedure
Once the general anesthesia has been performed, the tonsillectomy operation can be performed in various ways, all equally safe and effective; the choice of how to proceed lies with the surgeon, who may have preferences or be particularly expert in a given method.
MEDICAL STAFF
If the removal of the tonsils is the responsibility of a specialized surgeon, who is in charge of preparing the tonsillectomy procedure?
Pressure, body temperature and heart rate controls are usually performed by nurses on duty.
Anesthesia, on the other hand, is the responsibility of an anesthesiologist .
GENERAL ANESTHESIA
When it is said that a patient is placed under general anesthetic, it means that he is unconscious at the time of surgery. Therefore, he feels no pain, if not on awakening and at the conclusion of the operation.
Anesthetic drugs and painkillers are administered in different ways: intravenously, through a cannula inserted in the arm or hand; by inhalation, by means of a mask or a breathing tube; or finally, in 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 proper and regular breathing. Intubation is performed by inserting a tube into the mouth and almost to the trachea.
At the conclusion of the intervention, the anesthesiologist interrupts the drug administration until the patient's consciousness is resumed.
INTERVENTION METHODS
Tonsillectomy can be performed in at least 5 different ways:
- Classic surgical removal ( "cold" removal ). It is the typical operation performed with a steel scalpel, through which the tonsils are dissected, bound to the base and removed. Since the risk of hemorrhage is more than concrete, the surgeon uses anti-haemorrhagic substances or diathermy (see point 2), to close the blood vessels and thus block the release of blood from them. It is the most practiced method.
- Diathermy . A particular form of thermotherapy is performed with a probe crossed by a current (or an electrode); this, in contact with the tonsils, generates heat until it "burns" the lymph gland organs themselves. The advantage of this method consists in the fact that the bleeding is strongly limited (for this reason, it is also adopted in classical surgical removal).
- Coblation (or cold ablation ). The mechanism is similar to that of diathermy, only that the temperatures reached are lower (between 40 and 60 ° C). The destruction of the lymph glandular tissue of the tonsils takes place 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 scalpel, that is instruments that, in contact with the lymph gland tissue, cause high frequency vibrations. Also in this case, as for the laser, the danger of bleeding is reduced.
Some alternative techniques to traditional intervention - such as CO 2 laser ablation or radiofrequency ablation (in which heat is generated by electromagnetic radiation) - can be performed under local anesthesia without hospitalization; clearly this option can only be assessed in the adult and the collaborating adolescent.
Figure: coblation instruments, or cold ablation. From the site: www.arthrocareent.com
Figure: the "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 an hour.
DISCHARGE AND STATE OF POST-OPERATIVE HEALTH
The discharge, if the intervention was carried out without complications, can take place the same day or the morning after the operation. In fact, tonsillectomy is now considered an outpatient procedure, whose observation period can be limited to 4 to 8 hours post-surgery.
Upon awakening from anesthesia, the patient is offered a drink and a meal: among the drinks, it is better to avoid acidic drinks (for example, fruit juices), while, among foods, light, non-solid foods are recommended. easily swallowed.
Feeling pain, in addition to the mouth, also to the entire jaw, to the neck and to the ears is normal: for this reason, the methods of taking painkillers will be illustrated to the patient or family members.
In the first few days after surgery, it is likely to 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
Pain subsides within a week, but the first significant improvements are observed at the end of the second.
Hygiene
Especially in the beginning, hygiene is essential, since the operated individual is weak 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 to wash one's mouth and teeth thoroughly, by mouthwash, after every meal.
Supply
Although chewing and swallowing are difficult, it is good to gradually get used to eating solid foods. As noted above, acid drinks, alcohol and spicy foods should be avoided.
hemorrhage
In the first days after surgery, small bleeding from the mouth is normal. It can be useful, to interrupt them, to make gargles with cold water, since the cold has a vasoconstrictor effect. It is recommended not to take aspirin and derivatives, as painkillers, as they act against blood clotting (and promote bleeding).
Rest
For at least two weeks, stay at 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.
