Tonsillectomy or tonsillectomy refers to the complete removal of the palatine tonsils using surgical procedures. It is one of the most common operations, although nowadays it is no longer performed as a preventive measure, as was still very common in the 1970s.
What is tonsillectomy?
Tonsillectomy or tonsillectomy refers to the complete removal of the palatine tonsils using surgical procedures. Tonsillectomy is a routine procedure in which the palatine tonsils are surgically removed and is still the most common ear, nose, and throat surgery performed today. During the operation, the palatal arch is first cut open and then the tonsils are removed from the tonsil bed. Various methods are available for this, almost all of which nowadays aim to sclerose the tissue in such a way that postoperative bleeding is as rare as possible, which in very rare cases can even be fatal.
Function, effect, and goals
As recently as the 1970s, tonsillectomy was removed preventively in children to prevent inflammation of the tonsils. Today, it is believed that the tonsils, which are part of the lymphatic system, perform important work in the human immune system, and therefore surgery is performed only when inflammation refuses to subside or keeps returning even after repeated antibiotic treatment. Even if the infection has already become chronic, the only last resort is often the removal of the tonsils. Often the chronic infection is also accompanied by suppuration of the tonsils. In this case, tonsillectomy is also performed to counteract a spreading effect to other parts of the body by the bacteria responsible for the suppuration. If the tonsils are enlarged to such an extent that they hinder children in their breathing or in the case of proliferating tonsils, the adenoids, surgery on the tonsils is also often unavoidable. However, in these cases a so-called tonsillotomy, a partial removal, is often performed and only the proliferating tissue is removed. There are other reasons that make a tonsillectomy necessary, such as chronic swallowing difficulties or the suspicion of a tumor of the tonsils, but these are not as common as the causes listed above. Tonsillectomy is usually associated with a hospital stay that lasts from 3 to 8 days, depending on the course of the operation, medical history and risk of postoperative bleeding. The procedure itself takes about 30 minutes and is usually uncomplicated. Tonsillectomy is often performed with the use of a device called an electrocautery. This device removes tonsil tissue using intense heat while simultaneously sclerosing it, which reduces the likelihood of secondary bleeding. Other methods include the harmonic scalpel method, which uses ultrasound, radiofrequency ablation, which uses high-frequency radio waves, and carbon dioxide laser tonsillectomy, a special form of laser surgery using a carbon dioxide laser. All of these methods have in common that they heat and simultaneously sclerose the tissue. A method that works a little differently than those mentioned so far is called the thermal welding method. This has the advantage that it heats the tonsil tissue much less, which greatly reduces the patient’s pain following the operation. And also Bipolar Radiofrequency Ablation is a newer methodology that works without heat and removes tonsils by using high radiofrequencies. After the tonsils are removed, the blood vessels are tied off and any bleeding that may occur is stopped by electroagulation, which also uses heat to stop the bleeding. Pain after tonsillectomy is often experienced by patients as very severe and can last up to 4 weeks. A grace period of 2 weeks after a tonsillectomy is mandatory. During this time, no sports should be played, nor should any activities be performed that put a lot of stress on the neck and head area or cause blood to rush to the head, such as even washing hair with the head bent forward.
Risks, side effects, and hazards
The most common complication after tonsillectomy is postoperative bleeding, which occurs in about 1 to 4% of all surgeries.Children should therefore always remain under observation for the first three weeks after a tonsillectomy, as severe post-operative bleeding in them, due to the fact that they have far less blood than adults, may even be fatal if no helpful intervention is made in time. Particularly in young children, there is also a risk that they will choke on their own blood or that the blood will get into their lungs, causing them to cough, which in turn can intensify the bleeding. Bleeding due to detachment of scabs is most common in days 5 to 8 after surgery and is usually normal. As long as they stop on their own, there is no need to intervene in these cases. Only rarely do cases occur during tonsillectomy in which further surgery is needed to stop the bleeding. If severe bleeding occurs, the patient should first be placed in the stable lateral position. Cooling compresses around the neck can be helpful to at least slow down the blood flow. An ambulance should then be called immediately if there is no way to transport the patient to the hospital by the quickest route yourself.
