tonsillectomy

Tonsillectomy: description

The term tonsillectomy describes the surgical tonsil removal. Colloquially is often spoken of an almond operation (short: almond operation). This operation is mainly performed with repeated tonsillitis. Because children are most likely to develop tonsillitis, they are the main target of almond surgery. However, adults can also have their tonsils removed in certain cases.

Tonsillectomy: frequency

In Germany, tonsillectomy is one of the most common operations ever. Although the number has decreased slightly, approximately every 150th inpatient surgery is an almond operation. Outpatient tonsillectomy is usually not performed because of the high risk of rebleeding.

Tonsillectomy is performed differently in different countries. In Germany, about 54 out of every 10,000 children undergo an almond removal, while doctors in Ireland take out almonds in 118 out of every 10,000 children.

Tonsillectomy

In contrast to tonsillectomy, in a tonsillarotomy the palatine tonsils are only partially and not completely removed. The palatine tonsil is surrounded by a tissue capsule. In a tonsillotomy you can remove the tonsils while leaving the capsule on the palate. In addition, the larger vessels are spared, which supply the tonsils with blood. A tonsillotomy therefore less often leads to rebleeding.

Almond surgery in the form of tonsillotomy is also less painful. Although tissue of the palatine tonsils remains in the pharynx, in adolescent adults the number of annual sore throat episodes is reduced to almost the same extent as after a complete tonsil op (tonsillectomy). A tonsillotomy is especially considered for very large almonds.

Tonsillectomy: When will it be performed?

A tonsillectomy is not without danger and does not always lead to the expected success. Whether or not it is done on a case-by-case basis depends on how many medically diagnosed and antibiotic-treated purulent tonsillitis patients have had in the last 12 months:

• <3 tonsillitis: No tonsillectomy / tonsillotomy.
• 3 to 5 tonsillitis: A tonsillectomy / tonsillotomy may be performed if more episodes occur within the next six months and then the number 6 is reached.
• 6 or more tonsillitis: A tonsillectomy / tonsillotomy is indicated.

A peritonsillar abscess can be tried by the doctor to “empty” (by needle puncture or incision drainage). At the same time, the patient must take antibiotics. If this treatment is unsuccessful or there are complications from the abscess, it is surgically removed along with the affected palatine tonsil (abscess tonsillectomy).

Almond OP: Procedure

Before a tonsillectomy patients (in the case of minors: the legal guardians) are informed by the doctor about the operational risks. Once the patients (or guardians) consent to the operation, further preparations are made: the patient is bled and examined in the laboratory. Above all, the blood clotting is determined to estimate the risk of bleeding.

Before surgery, the patient must be fasted for at least six hours. He usually receives a sedative tablet and is dressed sterile. Then he is given a venous access. The anesthetist lets the patient inhale oxygen through a breathing mask and gives him various medications. Pain medications prevent the patient from experiencing pain during tonsillectomy. In addition, an antibiotic can be administered to prevent infections. Once the patient has fallen asleep, he is intubated and ventilated via the hose of the anesthesia machine. He gets nothing from the procedure during the entire almond operation period.

The patient’s head is stored slightly lower and slightly overstretched. A metal device in the mouth prevents the mouth from closing or the tongue from lying in front of the palatine tonsils. Then the palatine tonsils are successively released from the pharyngeal wall with a sharp knife. Bleeding is stopped or sutured with an electric current. In most cases, threads are used which dissolve spontaneously after some time.

The tonsil operation duration is usually 20 to 30 minutes. After surgery, the patient is first monitored in the recovery room. After five to eight days, he can be released from the hospital if there are no complications.

Tonsillectomy: chances of success

A tonsillectomy definitely does not protect against re-infections of the pharynx. However, some scientific studies have shown that, especially in the six months following the operation, less tonsillitis occurs. Especially children who have missed many school lessons due to tonsillitis have benefited. After a tonsillectomy, they often had to stay away from teaching for illness.

Tonsillectomy: consequences and risks

Almost every patient has pain after an almond operation. These may increase in the six days after a tonsillectomy. In contrast, sufferers can suck ice like an tonsillitis. If this does not relieve the pain sufficiently, analgesics such as acetaminophen are administered at an appropriate dosage.

Since many patients are ill after the operation, they are given the steroid dexamethasone during the operation. In addition, medications for nausea can be given after surgery.

bleeding

Tonsillectomy is relatively often associated with rebleeding compared to other surgeries. Although almond surgery and postoperative monitoring are routine procedures, rebleeding is not uncommon. However, they do not represent a treatment error in tonsillectomy – various surgical techniques have not been able to lower the risk so far.

How do these bleedings come about? The palatine tonsil is supplied with blood by several arteries. These arteries can be injured in a tonsillectomy and cause severe bleeding. During surgery, the doctor may stop an acute bleeding by stopping the vessel, or by desoldering or suturing the tissue with an electric current. However, there is no compression bandage such as an arm injury or something similar that stops bleeding again. Blood vessels on the neck can be compressed badly, without depressing the trachea at the same time. If a vascular injury recurs after a tonsillectomy, heavy bleeding can often only be stopped by another operation.

About a week after tonsillectomy, the scab detached from the pharyngeal wall. This period carries a high risk of rebleeding, which in the worst case can be fatal. Bleeding after a tonsillectomy is especially tragic in young children. These have a smaller total blood volume in the body than adults, so they can lose more blood even with minor bleeding percentage. Because of this, especially young patients after a tonsillectomy must be monitored without interruption until the wounds have completely healed.

nerve injuries

In addition, in a tonsillectomy nerves can be injured. This can change the taste and feel in the mouth. The tongue may be less able to move and swallowing may be impaired. Nerve injuries are very rare.

General surgery risks

In addition to the specific risks of removing tonsils, there are still the general risks of surgical intervention. These include, for example, an allergic reaction or intolerance to the drugs used, intubation injuries (such as tooth damage) or wound healing disorders. It should therefore be weighed in individual cases, as necessary one tonsillectomy is.