Everyone is familiar with sore throat with angina. This is an unpleasant symptom, but in cold weather, almost everyone faces it. Chronic tonsillitis is called tonsillitis. This disease is characterized by inflammation of the tonsils (tonsils). In the chronic form, exacerbations can occur 4 times a year or more. In severe cases, doctors suggest removal of the tonsils. Scientifically, such an operation is called tonsillectomy. It has its advantages and disadvantages, but sometimes you can not do without removal of the tonsils. As with any surgery, tonsillectomy has special indications. If you can do without removing the tonsils, it is recommended to save them. In such cases, one should confine oneself to conservative therapy and to prevent exacerbations of tonsillitis.
The functions of the glands and adenoids
Tonsils belong to the immune structures. They are necessary to protect the body from the penetration of infectious agents. In the human body there are several groups of tonsils. All of them are combined into a single immune structure - the Pirogov-Waldeyer ring. It includes 2 paired and 2 single tonsils. The most famous of them are the glands. This is due to their location. Palatine tonsils are located in the oral cavity and are the first to meet with microbes that enter the body. The glands are composed of lymphoid tissue, so they immediately begin to fight the infection. This is accompanied by their increase and sore throat.
Another structure included in the Pirogov-Waldeyer ring is the unpaired nasopharyngeal tonsil. It is popularly known as adenoids. Most often, this tonsil is inflamed in children. Its increase is accompanied by difficulty breathing in infants. Therefore, in severe cases, adenoids are recommended to be removed. Like the glands, the nasopharyngeal tonsil is composed of lymphoid tissue. With age, it gradually decreases in size. Adenoids protect the sinuses and lower respiratory tract from bacteria.
Indications for tonsillectomy
There are a number of cases where an operation to remove glands is necessary. First of all, this is the closure of the respiratory tract. Sometimes the glands increase so much that air cannot enter the body in sufficient quantities. An extreme degree of tonsil hypertrophy is an absolute indication for tonsillectomy. In addition, the following indications for gland removal surgery are distinguished:
- Angina, not amenable to conservative therapy.
- Frequent relapses and severe tonsillitis.
- The development of purulent complications. Among them are pharyngeal and paratonsillar abscesses.
- The risk of serious diseases developing against a sore throat. Similar pathologies include: myocarditis, glomerulonephritis and vasculitis.
Indications for the removal of adenoids are frequent relapses of the infection and shortness of breath. If, despite the ongoing drug therapy, the nasopharyngeal tonsil is constantly increasing, surgical treatment is performed. Otherwise, the child will experience oxygen deficiency, which will provoke more serious complications. Among them - chronic sinusitis, otitis media, cerebral ischemia and even respiratory arrest.
It should be understood that in the presence of the listed indications, the removal of the tonsils and adenoids is a necessary measure - it is impossible to do without surgical treatment. Parents whose children are at risk of complications should first of all take into account the opinion of the attending doctor.
Advantages and disadvantages of surgery
Given the protective function of the tonsils, removal of the tonsils should be considered as a last resort. After tonsillectomy, the barrier that delayed infection disappears. Therefore, the risk of bacteria entering the lower respiratory tract is significantly increased. People who have no palatine tonsils are more likely to experience more serious illnesses than tonsillitis. Among them - bronchitis and pneumonia. This is especially true for the removal of the tonsils in children. After all, babies are more susceptible to viral infections, therefore, they often suffer from colds.
Despite the shortcomings, tonsillectomy is one of the most common operations on ENT organs. Earlier removal of the tonsils in children and adults was carried out more often. Currently, doctors are trying to save tonsils and treat tonsillitis with medications. However, in the presence of absolute indications for surgery, tonsillectomy cannot be postponed. The benefits of this surgery include:
- Removing a permanent source of infection.
- Improved patency of the upper respiratory tract.
- Getting rid of persistent symptoms of tonsillitis.
It is up to the attending physician to decide whether or not to have surgery. It is impossible to independently decide on the performance of tonsillectomy. Only the otolaryngologist knows: is it possible to save the organ or not. If there is evidence, removal of the tonsils is a mandatory procedure. Only a tonsillectomy will help improve the patient's condition and avoid complications of angina.
Preparation for surgery
Tonsillectomy is a simple surgical procedure for experienced doctors. First of all, the doctor will determine how the glands will be removed. The choice of anesthesia method and preparation for surgery depend on this. Before performing a tonsillectomy, the doctor familiarizes himself with the results of the analysis of the patient. They should be normal. In the presence of an acute inflammatory process, the operation is postponed until the patient recovers. Special premedication is not required. On the eve of surgery, the patient should not eat. Only a light dinner is allowed. If tonsillectomy is performed in a classical way, general anesthesia is needed, which is carried out using a mask. Laser removal of glands is performed under local anesthesia. In this case, sedatives are administered to the patient.
Ways to perform tonsillectomy
The operation to remove tonsils has been known for several centuries. During this time, the technique of performing tonsillectomy has not changed much. The traditional removal of the tonsils in adults is carried out using a special loop, surgical scissors and a scalpel. In addition to classical tonsillectomy, a number of modern methods are distinguished. These include:
- Laser removal of tonsils.
- Operation with an ultrasonic scalpel.
- Radiofrequency ablation.
- Cryodestruction.
Each of these methods allows you to save the patient from chronic sore throat. Some methods of tonsillectomy allow you to save part of the tonsils, others - to remove the lymphoid tissue completely. The choice of methodology depends on the equipment of the medical institution, the presence of contraindications and the clinical picture.
Adenoid removal in children
Adenoids, in comparison with palatine tonsils, are located deeper. Therefore, they cannot be removed from the oral cavity without a special tool. In most cases, patients who are indicated for such an operation are preschool children. Preparation for surgery is the same as with tonsillectomy. The traditional removal of the nasopharyngeal tonsil is performed using Beckman adenotome. This instrument is wound behind a soft palate and covers the organ. With a quick movement, the nasopharyngeal tonsil is excised. After that, an adenotome is removed from the oral cavity. The patient is in a sitting position during the procedure.
Operation Technique
In most cases, gland removal in adult patients is performed by traditional surgical means. On average, tonsillectomy lasts from 20 to 40 minutes. The operation begins with cutting off the upper pole of the tonsil. For this purpose, a shallow incision of the mucous membrane and the introduction of a raspator per capsule of the gland are performed. The edge of the tonsil is fixed with a special clamp. Then the gland is separated from the palatine arches and the middle part is separated. The lower pole of the tonsils is removed using a loop, since there is no capsule in this area. The operation is completed by coagulation of bleeding vessels. A bed of palatine tonsils is plugged and ice is applied to the neck.
How is the postoperative period?
In the early postoperative period, the patient should be under the supervision of doctors. This is necessary to prevent bleeding and other complications. On the first day, the patient should not completely close his mouth and spit saliva. It is also forbidden to eat. Pain after removal of the tonsils is stopped with the help of analgesics. In the early postoperative period, it is not recommended to talk. The diet in the early days should include only liquid foods. To avoid infection of wounds and bleeding, antibiotics and hemostatics are prescribed. Such drugs include the drug "Ditsinon." It is necessary to observe voice peace, refrain from gargling and smoking.
Advantages and disadvantages of laser tonsillectomy
An alternative method of tonsillectomy is the removal of glands with a laser. This method has several advantages. Firstly, the operation is not accompanied by bleeding, as the vessels coagulate at the same time as performing tonsillectomy. Laser removal of tonsils is performed under local anesthesia in outpatient settings. This avoids not only hospitalization, but also the consequences of general anesthesia. Another indisputable advantage is minimizing pain.
Despite the advantages of laser surgery, it is worth noting that it is contraindicated in children under 10 years of age. A possible complication of this intervention is a burn of the oral mucosa. In addition, using a laser, it is not always possible to completely remove the lymphoid tissue, and there is a risk of a relapse of the pathology.
Possible consequences of gland removal
In most cases, tonsillectomy is successful. However, if the doctor's recommendations are not followed in the early postoperative period, dangerous consequences of gland removal may develop. This is primarily bleeding. Other early complications of surgery include wound infection and voice changes. Often there is hypertrophy of regional lymph nodes, and inflammation disappears 7-10 days after surgery. Antibacterial treatment is performed to prevent the spread of infection. The voice is restored on its own a few weeks after tonsillectomy. Long-term effects include a decrease in immunity. Due to the loss of the protective barrier, the patient is exposed to lower respiratory tract infections. To prevent this complication, the intake of vitamins and immunomodulators is recommended.
Removal of the tonsils: reviews of doctors
Tonsillectomy has a number of significant drawbacks, so it is not recommended to perform it without strict indications. If it is possible to save tonsils, doctors try to avoid removal of the tonsils. Reviews of doctors agree that it is necessary to treat angina with medication and to prevent exacerbations of tonsillitis. If conservative therapy is powerless, surgery cannot be avoided.