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Unfortunately, there may be a time when medical
therapy (antibiotics) 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. The best
recourse for both these conditions may be removal or reduction of the tonsils
and adenoids. The American Academy of Otolaryngology—Head and Neck Surgery
recommends that 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.
The tonsillectomy today:
The first report of tonsillectomy was made by
the Roman surgeon Celsus in 30 AD. He described scraping the tonsils and tearing
them out or picking them up with a hook and excising them with a scalpel. Today,
the scalpel is still the preferred surgical instrument of many ear, nose, and
throat specialists. However, there are other procedures available – the choice
may be dictated by the extent of the procedure (complete tonsil removal versus
partial tonsillectomy) and other considerations such as pain and post-operative
bleeding. A quick review of each procedure follows:
| Cold knife (steel) dissection: Removal of the tonsils by use of a
scalpel is the most common method practiced by otolaryngologists today.
The procedure requires the young patient to undergo general anesthesia;
the tonsils are completely removed with minimal post-operative
bleeding. |
| Electrocautery: Electrocautery burns the tonsillar tissue and assists
in reducing blood loss through cauterization. Research has shown that
the heat of electrocautery (400 degrees Celsius) results in thermal injury
to surrounding tissue. This may result in more discomfort during the
postoperative period. |
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Harmonic scalpel: This medical
device uses ultrasonic energy to vibrate its blade at 55,000 cycles per
second. Invisible to the naked eye, the vibration transfers energy to the
tissue, providing simultaneous cutting and coagulation. The temperature of
the surrounding tissue reaches 80 degrees Celsius. Proponents of this
procedure assert that the end result is precise cutting with minimal
thermal damage. |
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Radiofrequency ablation
(Somnoplasty):Monopolar radiofrequency thermal ablation
transfers radiofrequency energy to the tonsil tissue through
probes inserted in the tonsil. The procedure can
be performed in an office setting under light sedation or local
anesthesia. After the treatment is performed, scarring occurs within the
tonsil causing it to decrease in size over a period of several weeks. The
treatment can be performed several times. The advantages of this technique
are minimal discomfort, ease of operations, and immediate return to work
or school. Tonsillar tissue remains after the procedure but is less
prominent. This procedure is recommended for treating enlarged tonsils and
not chronic or recurrent tonsillitis. |
Carbon dioxide laser: Laser tonsil
ablation (LTA) finds the otolaryngologist employing a hand-held CO2 or KTP
laser to vaporize and remove tonsil tissue. This technique reduces tonsil
volume and eliminates recesses in the tonsils that collect chronic and
recurrent infections. This procedure is recommended for chronic recurrent
tonsillitis, chronic sore throats, severe halitosis, or airway obstruction
caused by enlarged tonsils.
The LTA is performed in 15 to 20
minutes in an office setting under local anesthesia. The patient leaves
the office with minimal discomfort and returns to school or work the next
day. Post-tonsillectomy bleeding may occur in two to five percent of
patients. Previous research studies state that laser technology provides
significantly less pain during the post-operative recovery of children,
resulting in less sleep disturbance, decreased morbidity, and less need
for medications. On the other hand, some believe that children are adverse
to outpatient procedures without sedation. |
Microdebrider: What is a
“microdebrider?” The microdebrider is a powered rotary shaving device with
continuous suction often used during sinus surgery. It is made up of a
cannula or tube, connected to a hand piece, which in turn is connected to
a motor with foot control and a suction device.
The endoscopic
microdebrider is used in performing a partial tonsillectomy, by partially
shaving the tonsils. This procedure entails eliminating the obstructive
portion of the tonsil while preserving the tonsillar capsule. A natural
biologic dressing is left in place over the pharyngeal muscles, preventing
injury, inflammation, and infection. The procedure results in less
post-operative pain, a more rapid recovery, and perhaps fewer delayed
complications. However, the partial tonsillectomy is suggested for
enlarged tonsils – not those that incur repeated infections. |
| Bipolar Radiofrequency Ablation
(Coblation): This procedure produces an ionized saline layer that
disrupts molecular bonds without using heat. As the energy is transferred
to the tissue, ionic dissociation occurs. This mechanism can be used to
remove all or only part of the tonsil. It is done under general anesthesia
in the operating room and can be used for enlarged tonsils and chronic or
recurrent infections. This causes removal of tissue with a thermal effect
of 45-85 C°. The advantages of this technique are less pain, faster
healing, and less post operative care. |
Consult
with your specialist regarding the optimum procedure to remove or reduce your
child’s tonsils and adenoids.
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