Tonsillectomy

Sometimes medical therapy fails to resolve the chronic tonsillar infections that affect your child. In other cases, your child may have enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep disorders.

You may be advised to have your tonsils removed in certain situations. In particular:

• If you have frequent and severe bouts of tonsillitis. This usually means:
• Seven or more episodes of tonsillitis in the preceding year.
• Five or more such episodes in each of the preceding two years.
• Three or more such episodes in each of the preceding three years.
• The bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.
• If you have large tonsils that are partially obstructing your airway, this may be a contributing factor to a condition called obstructive sleep apnoea syndrome.
• If you develop cancer of the tonsil.

The best recourse for such conditions may be removal or reduction of the tonsils. Children who have three or more tonsillar infections a year undergo a tonsillectomy; the young patient with a sleep disorder should be a candidate for removal or reduction of the enlarged tonsils. Tonsillectomy is one of the most common surgical procedures performed on children. It was also very painful. With the advent of new techniques, the post-operative period for the child is almost pain-free.

Various methods are available for removal of tonsils: Dissection and Snare method: This is the commonly used method to perform a tonsillectomy, in various parts of the country. The tonsil is dissected along with its capsule and lifted out of its bed. It is ultimately removed using a tonsillar snare. Snaring the tonsil has a distinct advantage. Since the tonsil is crushed before it is cut, bleeding is minimised. The advantage of this method is that the procedure is safe, bleeding is less and the tonsil can be removed in toto without any remnants.

Intracapsular Tonsillectomy: A microdebrider set at 1500 rpm in the oscillating mode is used to perform the intracapsular tonsil resection, and a thin rim of lymphoid tissue was left on the capsule. Suction cautery is used for hemostasis. This results in a decrease in postoperative pain and recovery time as compared to standard tonsillectomy.

Harmonic Scalpel Tonsillectomy: The harmonic scalpel is an ultrasonic dissector coagulator that utilizes ultrasonic vibration to cut and coagulate tissues. The cutting mechanism is possible with the sharp blade with a vibratory frequency of 55.5 kHz over a distance of 89 μm. The coagulation mechanism occurs by transferring mechanical energy to tissues. This breaks hydrogen bonds of proteins and generates heat from tissue friction. The temperature of the harmonic scalpel is lower than electrocautery (50° – 100° C, 150° – 400° C, respectively), and there is less thermal damage to tissues.

Laser Tonsillectomy: The CO2 and KTP lasers have been used to perform tonsil surgery. There is a less postoperative pain, more rapid healing, less blood loss, and less operative time using the CO2 laser. Although the patients have greater difficulty tolerating a diet two and three weeks postoperatively.

Coblation: Coblation, or cold ablation, is a technique that utilizes a field of plasma, or ionized sodium molecules, to ablate tissues. Bipolar radio-frequency energy is transferred to sodium ions, creating a thin layer of plasma. This effect is achieved at temperatures from 40° to 85° C, in comparison to electrocautery which can reach above 400° C. The reduction in thermal injury to surrounding tissues offers reduced postoperative pain and morbidity and an almost bloodless field intraoperatively.