The most common cause of snoring in children is enlarged tonsils and adenoids, and the common symptoms include nasal congestion, snoring, inattentiveness, coughing, and reduced learning ability. This has a great impact on the growth and development of children. When it comes to surgery, parents are often very worried and afraid. When it comes to tonsil and adenoidectomy, parents often ask, “How invasive is the surgery?” “Is it a minimally invasive surgery?” “Is it a plasma radiofrequency surgery?” and “Can my child tolerate this surgery?” “Is the tonsils removed with a laser?” In response to these questions from parents, I will now address the issue of tonsillectomy surgery. This is the reason why I am writing this article.
Regarding the order of tonsil and adenoidectomy, my personal practice is to remove the tonsils first and then the adenoids, i.e., to do the tonsils and then the adenoids, and to observe the blood leakage from the tonsillar fossa during the adenoidectomy for timely treatment.
The initial surgery is performed under local anesthesia, and within a few minutes the doctor uses a circle-shaped knife, called a tonsil squeeze cutter, to remove the tonsils, also known as the squeeze cut method. This is because the child does not cooperate well. And the child is very afraid, and it will leave a shadow on their psychology, so the squeezing method has been basically abandoned in large domestic hospitals.
Later, with the development of pediatric anesthesia technology, tonsillectomy surgery was changed to be performed under general anesthesia, but the method of tonsillectomy is still the peeling method of removal. The tonsil peeling technique is both a traditional and a very classical surgical method, in which the mucosa at the junction of the tonsils with the palatoglossal and palatopharyngeal arches is picked open. Later, electrocoagulation or low-temperature plasma radiofrequency can be used to stop the bleeding or directly close the wound with anterior and posterior palatal arch sutures.
Another method is to remove the tonsils with low-temperature plasma radiofrequency technique. Low-temperature plasma radiofrequency surgery is performed with radiofrequency energy plus sodium ions in physiological saline as the medium to stop the hemorrhage at a slightly higher than normal temperature of 40-70°C. The postoperative reaction is relatively mild, but the disadvantage is that the boundaries of the tonsil adhesions are unclear when they are heavy, and the normal shape of the palatal arch is not easily preserved. The techniques include: pulling the tonsils medially, operating along the tonsillar tegument, gradually ablating and separating the tonsils along the tonsillar tegument with the tip of the knife, and using the lateral edge of the knife to touch the tissue (with light force, similar to stroking) to cut off the tonsils completely.
For children with simple tonsillar hypertrophy and less inflammation, low-temperature plasma radiofrequency resection can be used; for children with recurrent inflammation, heavy adhesions, or obese children with a narrow pharyngeal cavity, traditional peeling surgery is more effective. The results will be better. Moreover, suturing the anterior and posterior palatal arches (usually with a portion of peritoneal tissue) is a simple method with positive results and avoids the possibility of postoperative pseudomembrane detachment for hemorrhage. After complete peeling of the tonsils, the wound is electrocoagulated to stop bleeding (mainly at the root lingual artery, where we have observed that the majority of postoperative bleeding from the tonsils is located), and the anterior and posterior palatal arches are sutured directly after excision, which not only stops bleeding but also eliminates the wound, and the operation time is controlled to 20-30 minutes, which greatly reduces the occurrence of postoperative bleeding. The benefit of suturing for obese pediatric patients with significantly narrow pharyngeal cavities is also that palatopharyngoplasty expands the pharyngeal cavity, and the postoperative results are better than those who simply remove adenoids and tonsils. Therefore, my personal experience has been to use the peel method to remove the tonsils, which is easy and fast, with less thermal damage.
Usually on the day the child receives the tonsils, we give them cold liquids such as milk, juice, yogurt, ice cream, etc. The next day they can eat warm semi-liquid foods such as noodles, porridge, cakes, ravioli, etc. After 7-10 days, when the white membranous material on the surface of the surgical wound has receded, they can eat a soft diet and resume their normal diet after 3-4 weeks. Some children may have fever for 3-5 days after surgery, which usually occurs after surgical procedures and is called “surgical fever”, but no special treatment is needed if the fever is not high. If the bleeding is small, it will stop on its own; if it is large and persistent, you should go to the hospital for emergency treatment. Snoring and open mouth whistling will not disappear immediately after the surgery, often because of wound edema, there will be aggravation within a few days, parents should not worry, it will usually slowly improve and disappear a week after the surgery. If a child undergoes adenoidectomy at the same time, it is also best to use endosonar nasal spray for 4 weeks and oral cetirizine hydrochloride for a week after surgery, and add oral anti-inflammatory drugs for 5-7 days if necessary. If a child has preoperative combined secretory otitis media, oral mucus promoter and ear drops should also be used for treatment after surgery, and a follow-up visit to the clinic must be made after surgery.
With advances in anesthesia and surgical techniques, tonsillectomy is now a safe, quick and routine procedure. Parents do not need to be overly concerned or afraid.