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21 January 2021 |

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Tonsillectomy technique has been changed from 2,000 years ago

 Tonsillectomy technique has been changed from 2,000 years ago. Today various techniques used to remove tonsils including removal of the tonsils by means of sharp instruments like knife. Other methods are  such as removal by electrocautery technique by laser and also a surgical procedure by radio frequency. In all these methods, the principles of surgery are the same in which the tonsil tissue is taken from its bed and bleeding in that location is controlled. However, the removal of the tonsils and blood after that can be done by any of these methods.

In surgical procedure by electrocautery, cutting and bleeding are done by electricity. In this method, the intraoperative bleeding is less. However, because of the burned tissue tonsil bed, after surgery, patients complain of pain. Of course this pain is only for a few days.

It is also possible to surgery tonsils by laser in which various lasers like CO2 laser and KTP laser are used.

The method which is used recently is radio frequency. In this method, by using electromagnetic waves the tissues around the tonsils are cut and tonsils are removed. The advantages of this method are less bleeding and better control of it and the possibility of tonsil surgery on an outpatient basis and in the office. However, since this method requires patient cooperation this method is not recommended for kids. Also it is not possible to use this method in Adenoids surgery.

Necessary actions before surgery;

The actions before surgery are examining the patient’s coagulation disorders, and if there is disorder it should be repaired. The most important thing is to control bleeding during surgery and after removing the tonsils from their beds, ear, nose and throat surgeon, must patiently and carefully control bleeding.

Necessary actions after tonsil surgery;

The most important thing after surgery is pain at the surgical place. This will be improved by relieving drugs. Due to the fragile nature of the tonsillar tissue in children, the intraoperative manipulation will be less and the pain of after surgery is low and most of  the patients do not complain from pain. But in adults, due to the tightness of the tonsils, they usually complain of the pain after surgery. For reducing pain, in addition to oral medication, it is recommended to use  ice cream and cold drinks after several hours of operation. Also, chewing gum and jaw movement, especially in adults help to reduce the pain.

Patients should use liquids for the first day after surgery and use soft food in the first 3 days. And then it is not troublesome to eat regular foods. Of course eating foods like the bottom of the pot or tight bread for a week is not recommended. Ear, nose and throat surgeons, often discharge patients from the hospital after 6 hours of operation.

However, some patients have to stay at least one night in the hospital. For example, patients with a history of bleeding disorders in themselves and their family or those who have difficulty breathing due to airway obstruction and sleep disturbance were candidates for tonsillectomy and those who have abnormalities in their jaws and faces. For example, patients with Down syndrome also have an overnight stay in the hospital after surgery. And the patients who have common diseases such as heart disease, lung disease, asthma and kidney should be monitored after surgery. After discharge, in the first three days after the surgery, the patients should be seen by an ear, nose and throat specialist. One of the points which patients usually refer in the first visit is having pain in the ear. This type of ear pain is reference and the cause of it is inflammation and pain in the tonsil bed which will be referred to ear. In fact the ears of these people don’t have any problem. We advise these people to move their jaws and to chew gum and use relieving drugs. This situation will improve over the next few days. Another important point is to start a diet and the action of swallowing. If the patient delay the start of diet due to the feeling of pain when swallowing food, it causes fear of swallowing which ultimately leads to stiffness and impaired movement of the soft palate. And in the case of continuation of low immobility and lack of swallowing it can cause problems in their talking. For this reason, I recommend that all patients to start eating despite the pain in the first few days after surgery


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