Tonsillectomy: Surgery of Tonsils by removing Tonsillitis

Tonsillectomy or Surgery of Tonsils is a technique of surgical removal of tonsils. Tonsils are the glands which are on the back of the throat, these are two oval shape tissues behind throat known as Tonsils. Tonsillectomy or Surgical removal of tonsils has the history of more then 3000 years.

Tonsillectomy was a common surgical producer when they become inflamed or infectious, but now tonsillectomy is done when the tonsils are inflamed or infectious frequently. Tonsils, sometime may also disturbed the breathing due to increases size of tonsils which may require surgical procedure to clear the way of air.

There are three types of Indications which makes the surgery of tonsils necessary, these are as follows;

Absolute
Relative
Part of other Surgery

Absolute:

Most common indication is Recurrent infections of throat with duration of seven or more episodes in one year, or five episodes per year for 2 year, or three episodes per year for 3 year, or two weeks or more of lost school or work in one year. Peritonsillar abscess, In children, tonsillectomy is done 4-6weeks after abscess has been treated. in adults, second attack of peritonsiller abscess forms absolute indication, Hypertrophied tonsils causing sleep apnoea, difficulty in deglutition and interference with speech. Tonsillitis causing febrile seizures and when there is suspicion of malignancy, Unilaterally enlarged tonsil may be a lymphoma in children and epidermoid cacinoma in adults. Biopsy can taken.

Relative:

Streptococcal carriers, who may be the source of infections to others. Diphtheria carries, who do not respond to antibiotics may be the source of infection to other, Recurrent streptococcal Tonsillitis in patient with cardiac vulvular diseases, Chronic Tonsillitis with bad taste which is unresponsive to medical treatment.

Part of other Surgery:

In Glossopharyngeal Neurectomy, tonsil is removed first and then 9th cranial nerve is served in the bed of tonsil, in palatopharyngeoplasty which is done for sleep apnea syndrome and for removal of styloid process.

Surgery of Tonsils

Anesthesia:

Done under general anesthesia with endotracheal intubation. In adult, It may be done under local anesthesia.

Position:

Rose Position, i.e, patient lies supine with head extended by placing a pillow under the shoulder. A rubber ring is placed under the head to stabilize it. Hyperextension should be prevented.

Types of Surgical Procedures for Tonsils

There are two types of techniques used for tonsillectomy operation:

Cold Tonsillectomy:

Dissection and snare method, This method is most widely used, while other methods are intracapsular tonsillectomy, Plasma mediated ablation technique, Guilotine method, Hormonic scalpel or ultrasound method and cryosurgical technique.

Hot Tonsillectomy:

These are Laser tonsillectomy, Radiofrequency, Electrocautery and cablation tonsillectomy

Methods of Surgical Procedures for Tonsils

Dissection and Snare Method:

First Boyle Davis mouth gag is introduced and opened. It is held in placed by Draffin,s Bipods or s string over a pulley, Tonsil is grasped with tonsil holding forceps and then pulled medially then incision is made in the mucous membrane where it reflects from the tonsil to anterior pillar. lt may be extended along the upper pole to mucous membrane between the tonsil and posterior pillar. then dissect the tonsil from the peritonillar tissue and separate its upper pole, Now the tonsil is held at its upper pole and traction applied downwards and medially dissection is continued with tonsillar dissector or scissors until lower pole is reached now wire loop of tonsillar snare is threaded over the tonsil on to its pedicle, tightened and the pedicle is cut and tonsil is removed then a gauze sponge is placed in the fosse and pressure applied for a few minutes and lastly bleeding points are tied with silk and the procedure is repeated on the other side.

Other method for Tonsillectmy:

Electrocautry both unipolar and bipolar electrocautery has been used. lt reduces blood loss but causes thermal injury to tissues. Laser tonsllectomy lt is indicated in coagulation, Guillotine method can be done only when tonsils are mobile and tonsil bed has not been scarred by repeated infections. It is largely abandoned now days. Intrascapular tonsillectomy, with the use of powered instrument tonsills is removed but its capsule is preserved to reduce post-operative pain, Cryosurgical technique, In this tonsil is frozen by application of cryoprobe. Two applications, each of 3-4 minutes, are applied tonsillar tissue will undergo necrosis and later fall off leaving a granulating surface. Bleeding is less due to thrombosis of vessels caused by freezing. Harmonic scalpel, lt uses ultrasound to cut and coagulate tissues. lt is a cold method with less tissue damage and post operative pain, Plasrna mediated ablation technique, in this ablation method, protons are energized to break molecular bonds between tissues. lt is a cold method and does not cause thermal injury. Cablation tonsillectomy is another type of hot technique, Laser tonsillotomy, it aims to reduce the size of tonsills. It indicated in the patients who are unable to tolerate general anesthesia. Tonsils are reduced by laser ablation up to anterior pillar by stage repeated applications.

Author: Dr. Faiqa