With the intensive use of low-temperature plasma technology, the amount of bleeding during the procedure is minimal, usually less than 2 ml (of course, it also depends on the operator’s proficiency). Hemostasis during surgery while decortication makes it possible to preserve the tonsillar envelope or to preserve part of the tonsils. Preserving part of the tonsils or even just the tonsillar envelope is of great significance for younger children with developing immune systems.
We are talking about partial tonsillectomy or intra-tonsillectomy, which is different from the traditional tonsil ablation surgery.
Surgery is indicated for.
1.Children with snoring caused mainly by tonsils and adenoids, who do not have frequent purulent infection in their own tonsils, can undergo major tonsil excision with complete removal of adenoids.
2, tonsils greater than 2 degrees, partly greater than 3 degrees, a simple tonsil low temperature plasma ablation, can not effectively reduce the anterior and posterior diameter of tonsils, can not effectively expand the postoperative pharyngeal cavity, can carry out a large part of tonsil removal.
Contraindications to surgery.
1, recurrent purulent tonsillar infections, more than 4 times a year, in order to lift focal tonsillitis, total tonsillectomy should be performed.
2.Tonsils of more than 3 degrees, accompanied by excessive lymphoid tissue hyperplasia in the pharynx, total tonsil excision is recommended.
3, Those who have autoimmune diseases and other contraindications to tonsil surgical excision are also not suitable for low-temperature plasma ablation, partial release or tonsillectomy with preservation of the envelope.
Advantages.
1, still maintain the advantage of basically no bleeding during the surgery, the same can solve the problem of oversized tonsils left and right diameter and anterior and posterior diameter, and as effective as total excision to expand the role of the pharyngeal cavity.
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.Postoperative secondary 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. During the decortication period, secondary bleeding after tonsil surgery is effectively reduced 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, major 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 has a non-negligible effect on immune development in younger children (<8 years old), which is of great concern to many parents of children with this condition.
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 huge advantages. In addition, because the permeability of low temperature plasma is less than 0,3mm, there appears to be no bleeding during the surgery, and the primary bleeding within 24 hours after the surgery is slightly more than that of the low temperature plasma tonsil total excision. It also has a lot to do with the skill and proficiency of the surgeon.
2, for the tonsil removal how much, there is no a standard, all rely on the surgeon to master, especially the treatment of the anterior and posterior diameter of the tonsil, must be thorough, otherwise the surgery becomes ablation, the postoperative effect is poor, lost the meaning of surgery.
3. Since the residual tonsils will undergo compensatory hyperplasia after total adenoid excision, 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 who are at the age of high lymphoid tissue hyperplasia, 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.