Tonsillectomy: Description
The term tonsillectomy describes the surgical removal of the tonsils. Colloquially, one often speaks of a tonsil operation (short: tonsil surgery). This operation is mainly performed in case of repeated tonsillitis. Since children most often suffer from tonsillitis, they are the main target group for tonsil surgery. Adults also have their tonsils removed in certain cases.
Tonsillectomy: Frequency
In Germany, tonsillectomy is one of the most common surgeries of all, although the number has decreased in recent years. In 2018, more than 61,300 tonsillectomies were performed in this country. In another 12,750 patients, doctors also cut out the adenoids at the same time as the palatine tonsils (tonsillectomy with adenotomy).
Tonsillotomy
In contrast to tonsillectomy, surgeons remove only part of the palatine tonsils in a tonsillotomy, not all of them:
Each palatine tonsil is surrounded by a connective tissue capsule. During a tonsillotomy, the surgeon usually removes most of the tonsil, but leaves the lateral portion and the capsule in the palate. The larger vessels that supply blood to the tonsils are spared. A tonsillotomy therefore less often leads to postoperative bleeding.
Other benefits of tonsillotomy include:
- Shorter operation time
- Less blood loss during surgery
- Less pain after surgery
- Consequently, less painkiller intake
- Patients can eat again earlier
- Partial preservation of the defensive function of the tonsils, especially in young children
Comparison tonsillectomy and tonsillotomy
However, it is unclear how effective a partial removal of the tonsils (tonsillotomy) can be in preventing recurrence of tonsillitis, especially in the long term. There are still too few conclusive studies that have investigated how a partial removal compares with a complete removal of the tonsils (tonsillectomy).
Tonsillectomy: When is it performed?
A tonsillectomy is not without danger and does not always lead to the expected success. Whether or not it is performed in an individual case depends on how many medically diagnosed and antibiotic-treated purulent tonsillitis cases the patient has had in the last twelve months.
- < 3 tonsillitis cases: No tonsillectomy
- 6 or more tonsillitis episodes: Tonsillectomy is indicated.
The same criteria also apply to partial tonsillectomy (tonsillotomy).
Peritonsillar abscess
Other indications for tonsillectomy
In addition, there are other cases in which experts recommend a complete tonsillectomy – regardless of whether the affected person suffers from increased inflammation:
- PFAPA syndrome (periodic fever syndrome)
- Acute inflammation of the renal corpuscles (glomerulonephritis) in the presence of streptococcal tonsillitis
- Unilaterally enlarged tonsil (if purely unilateral enlargement occurs, a cancerous focus must be excluded)
This is a febrile illness also called periodic fever syndrome. It usually occurs in children between the ages of two and five. Affected individuals experience regular episodes of fever that last about five days. In addition, the children:
- Inflammation of the oral mucosa (stomatitis), often with small open sores (aphthae).
- Inflammation of the throat (pharyngitis)
- Swollen lymph nodes in the neck
- If necessary, also abdominal pain, headache and fatigue
Tonsillectomy: Procedure
Before tonsillectomy, the patient is informed – the doctor explains the risks of the surgery to the patient (in case of minors: to the legal guardians). Once the patient (or guardian) consents to the tonsillectomy, further preparations are made: Blood is drawn from the patient and examined in the laboratory. Doctors pay particular attention to blood clotting to assess the risk of bleeding.
Anesthesia
Procedure of tonsil surgery
The patient’s head is positioned slightly lower and slightly hyperextended. A metal device in the mouth prevents the mouth from closing or the tongue from lying in front of the palatine tonsils. Then the surgeon detaches the palatine tonsils from the pharyngeal wall using surgical instruments. This also involves cutting various vessels on the outside of the tonsil – unlike tonsillotomy. There are two methods for this:
- “Cold” dissection: tonsillectomy is performed without electrical current.
Bleeding is either stopped with an electric current or sutured. Most often, the surgeon uses sutures in the process, which dissolve on their own after some time.
The duration of tonsil surgery is usually 15 to 30 minutes. After the operation, the patient is initially monitored in the recovery room. After a few days he can leave the hospital, provided that no complications arise.
Tonsillectomy definitely does not protect against recurrence of throat infections. However, some scientific studies have shown that fewer tonsillitis infections occur, especially in the first year after tonsil surgery. According to these studies, children who had missed many school lessons due to tonsillitis benefited the most. After tonsillectomy, they had to be absent from school less often due to illness.
Tonsillectomy: consequences and risks
Practically every patient experiences pain after tonsil surgery. However, this usually subsides after a few days. Until then, affected patients can suck ice (no fruit ice because of the acidity, no pieces!) as in the case of tonsillitis to relieve the pain. If necessary, patients are also given painkillers, for example in the form of tablets, suppositories or as a spray.
Nausea and vomiting, which often occur after surgery, can also be treated with medication.
Bleeding
Compared to other operations, tonsillectomy is associated with a relatively high incidence of postoperative bleeding. Although tonsillectomy is a routine operation in hospitals, postoperative bleeding is not uncommon. However, they do not represent a treatment error of tonsillectomy. Despite various surgical techniques, a relevant risk of bleeding remains.
The palatine tonsil is supplied with blood by several arteries. During surgery, the doctor can stop acute bleeding by either sclerosing the vessel with an electric current or suturing it. However, he cannot apply a compression bandage to prevent (re)bleeding as he would, for example, in the case of an arm injury. If a vessel injury opens up again after a tonsillectomy, severe bleeding can often only be stopped by a new operation.
Secondary bleeding
Approximately one week after tonsillectomy, the eschar detaches from the pharyngeal wall. This period carries a high risk of secondary bleeding, which in the worst case can be fatal. For this reason, young patients in particular must be carefully monitored after tonsillectomy until the wounds have completely healed.
Any bleeding after tonsillectomy must be taken seriously, even if it appears mild at first. It is an emergency! Therefore, rapid transport by ambulance to a hospital is necessary for any tonsillectomy post-operative bleeding.
Nerve injuries
General surgical risks
In addition to the specific risks of a tonsillectomy, there are also the general risks of a surgical procedure. These include, for example, an allergic reaction or intolerance to the medications used, infections, injuries – including those caused by intubation (such as tooth damage) – or wound healing problems. It should therefore be well weighed up in each individual case how necessary a tonsillectomy is.
The pain usually decreases within the first week after tonsil surgery. Severe sore throat can be successfully counteracted with painkillers. The operating medical team or the family doctor will prescribe the appropriate medication. Cold ice can also help. However, make sure to use rather soft ice – for example milk ice – without fruit acid or chunks.
- Solid food with hard pieces like seeds, nuts, brittle or sharp edges like chips
- Fish with bones
- Acids, such as from fruits or vegetables (e.g., tomatoes)
- Spicy foods
- Hot food
- Carbonated drinks
- Alcohol
Instead, these foods are suitable after tonsil surgery:
- Soft, pureed food
- Soups
- Noodles
- White bread or mixed bread without crust (spreadable sausage or spreadable cheese is suitable as a topping)
- Yogurt
- Water, milk, unsweetened tea
- Do not smoke!
- Do not exert yourself excessively during the first two to three weeks (no weight lifting, no sports, etc.).
- Avoid activities that increase blood flow excessively such as sunbathing, solarium visits or hot showers.
- Drink plenty of water!
- Call the rescue service immediately!
- The blood must be spat out! Do not choke in the process!
- Placing an ice pack on the back of the neck can help to slow down the bleeding as the vessels contract. A bag of frozen vegetables, for example, is also suitable for this purpose.
- Do not drive yourself or your child! In the ambulance called instead, the first steps against bleeding after tonsillectomy can already be taken.
