With the intensive use of low-temperature plasma technology, the amount of bleeding during surgery is minimal, generally no more than 2 ml (of course, it also depends on the operator’s proficiency). The hemostasis of the tonsil envelope or part of the tonsils can be preserved during the surgery. Preserving part of the tonsils or even just the tonsillar envelope is of great significance for younger children whose immune systems are developing. What we are talking about now is a major tonsillectomy or intra-tonsillectomy, which is different from the traditional tonsil ablation surgery. In case of children with snoring caused mainly by tonsils and adenoids and without frequent purulent infections of their own tonsils, partial tonsillectomy can be performed if the adenoids are completely removed. 2. If the tonsils are larger than 2 degrees and partly larger than 3 degrees and simple tonsil low-temperature plasma ablation cannot effectively reduce the anterior and posterior diameter of the tonsils or effectively expand the postoperative pharyngeal cavity, major tonsil excision can be performed. Contraindications to surgery: 1. For recurrent purulent tonsillar infections, more than 4 times a year, total tonsillectomy should be performed to relieve focal tonsillitis. 2. Total tonsillectomy is recommended for tonsils with more than 3 degrees of lymphatic tissue hyperplasia in the pharynx. 3. Those who have autoimmune diseases and other contraindications to surgical removal of tonsils are also not suitable for low-temperature plasma ablation, partial release or tonsillectomy with preservation of the envelope. Advantages: 1. It still maintains the advantage of no bleeding during surgery, and can also solve the problem of oversized left and right tonsil diameters and anterior and posterior diameters, and achieve the same effect of effectively expanding the pharyngeal cavity as total excision. 2. Basically, the anterior and posterior palatal arches will not be destroyed, and the natural state of the palatal arches will be maintained, so the edema is light and the postoperative effect on speech is minimal. 3. Preserve part of the tonsils or tonsil envelope, especially not to damage the lateral wall of the tonsils, basically not to destroy the pharyngeal contraction muscle group, postoperative pain is significantly reduced, swallowing function is not affected, and postoperative recovery is fast. 4. The secondary postoperative bleeding (bleeding during the postoperative 6-8 days decortication period) was zero in the majority of resected patients in the past 2 years. Since the lateral wall envelope of the tonsil is preserved, the damage to the blood vessels entering the upper and lower poles of the tonsil is effectively avoided, and secondary bleeding after tonsil surgery is effectively reduced during the decortication period due to the protection of the residual tonsil. In the summary of the surgery in the past 2 years, although the secondary bleeding rate of total tonsil excision is low (4-6 cases of secondary bleeding in nearly 400 cases per year), the secondary bleeding of intraperitoneal resection, gross tonsil excision, and tonsil ablation is zero. 5. Preserving some of the tonsils can be of great help in preserving immunity in younger children. Studies have shown that even just preserving the tonsillar envelope, for younger children (<8<
span=””>years old) has a non-negligible effect on the development of immunity, which is of great concern to many parents of affected children. Disadvantages: 1. Primary bleeding or increased, because the tonsils are rich in vascular tissue, surgery touching the arterial vessels will have bleeding phenomenon, properly handled generally generally will not exceed 2ml, compared to the traditional stripping or a huge advantage. In addition, because the permeability of low temperature plasma is less than 0.3mm, there appears to be no bleeding during surgery and slightly more primary bleeding than low temperature plasma tonsil total excision within 24 hours after surgery. It also has a lot to do with the skill and proficiency of the surgeon. 2. There is no standard for how much tonsils are removed, it all depends on the surgeon, especially the treatment of the anterior and posterior diameter of the tonsils, which must be thorough, otherwise the surgery becomes an ablation and the postoperative effect is poor and the meaning of the surgery is lost. 3. Since the residual tonsils will undergo compensatory hyperplasia after total excision of adenoids, the long-term postoperative effect remains to be observed, and there is very little domestic literature in this regard. Especially for overly enlarged tonsils, and younger children under 3 years old, they are at the age of high lymphoid tissue proliferation. Although it is important to preserve part of the tonsils, it remains to be collected and confirmed by clinical data whether snoring will recur after 3-4 years. In conclusion, due to the advent of low-temperature plasma technology and the increase of surgical practice, intraperitoneal tonsillectomy or major tonsillectomy is a big trend for children, especially for younger children. During surgery, attention must be paid to the adequate treatment of the anterior and posterior tonsil diameters, the protection of the tonsil envelope, especially the protection of the middle pole lateral wall of the tonsil envelope (to reduce bleeding), and the selection of the site for preserving the tonsils, all with sufficient consideration to achieve both good postoperative results and to preserve the child’s immunity to the greatest extent.