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Tonsillectomy - palatine tonsills excision

Schemat zdrowych migdałków podniebiennych

Pic. 1 - Normal palatine tonsills

Schemat przerostu migdałków podniebiennych z masami zalegającego detrytu w poszerzonych kryptach migdałkowych

There are two main indications for palatine tonsills excision. Firstly it is recurrent staphylococcal pharyngitis and its complications (i.e. peritonsillar abscess), which failed to resolve with the conservative treatment. Untreated, it is likely to develop the rheumatic fever with heart valves, kidneys and joints involvement. Second main indication is middle pharynx mechanical blockage due to massive hypertrophy of the palatine tonsills. It produces snoring, apnoea and troubles with breathing and swallowing.

In both cases the palatine tonsills should be entirely excised as they are the source of bacterial biofilm and superantigens which by activation the human immune system affect distant organs.

 

Nowadays, tonsillectomy is performed under the general anaesthesia with the tracheal intubation to protect lower airways. In most cases both tonsills are being removed due to the factors mentioned above. The procedure lasts for about 40-60 minutes. Postoperative wound is usually supplied with one or two absorbable sutures in the lower pole to close it and to prevent bleeding from main arterial sources.

 

In the postoperative follow-up, extensive physical exertion should be avoided and the meals should not be too hot, spicy or rough in consistency. Throat can be safely flushed with painkiller fluids (i.e. Elmex).

 

The most severe and rare complication of tonsillectomy is bleeding. It happens most frequently in the 7-10 days postoperatively. If it happens, Patient should spit out the blood, put some ice on the neck and call the ambulance if there is more than several drops of blood in the sputum. In case of extensive bleeding surgical intervention and vessels ligation may be required.

 

Pic. 2 - Palatine tonsills hypertrophy with tonsillar stones in the deep crypts

Tonsillotomy - palatine tonsills debulking

Debulking of the palatine tonsills volume is considered in cases of the extensive hypertrophy, causing blockage of the middle pharyngeal space, but with no chronic or recurrent infections.

 

This clinical presentation is most common in children and the tonsillotomy is usually combined with adenoidectomy due to the adenoid hypertrophy.  It is done under the general anaesthesia with several surgical techniques - "cold" surgery, electrosurgery, laser and cryosurgery.

 

Complications are very rare and benign.

Rafał Chmielewski - ZnanyLekarz.pl