Tonsils are the lymphatic tissue masses under the mucous membrane at the top of the postnasal orifice, oropharynx and both sides of the back of the tongue.
The tonsils are more developed in childhood and tend to atrophy in adulthood. The palatine tonsil is the largest part of the tonsil family, and for this reason, it is commonly referred to as the tonsil, so named because of its depressed surface, which resembles the shape of the nucleus of a lentil. The pharyngeal tonsils are also known as adenoids and proliferators, and because of their hidden location, the lesions caused by them are not easily noticed and are easily overlooked. The tonsils of normal children are larger, especially at the age of 5-6, because they have an immune function, and being large means that they are active, and being enlarged cannot be the basis for surgery. If tonsillitis is recurrent and adversely affects the whole body, or if the tonsils have become a focal point for nephritis, heart disease, joint inflammation, etc., surgical removal of the tonsils may be considered. When the tonsils are so large that they interfere with breathing and swallowing and cause snoring and breath-holding during sleep at night, the tonsils, including the adenoids, should be considered for removal. In children, especially young children, the tonsils are highly hyperplastic, causing partial obstruction of the upper respiratory tract, resulting in obstructive apnea during sleep, which can lead to pulmonary hypertension due to long-term oxygen deprivation and carbon dioxide accumulation, causing diseases such as tonsil-pulmonary heart disease and tonsil-brain syndrome.
Indications for surgery.
(1) Recurrent acute attacks of chronic tonsillitis or repeated complications of peri-tonsillar abscesses.
(2) Severe tonsillar hypertrophy, which hinders swallowing and breathing.
(3) Chronic tonsillitis has become a lesion causing lesions in other organs of the body; acute inflammation of the upper respiratory tract and acute otitis media are clearly associated with tonsillitis.
(4) Diphtheria carriers, when conservative treatment is ineffective.
(5) Various benign tonsillar tumors can be removed together with the tonsils; for malignant tumors, cases should be carefully selected
Contraindications
(1) Surgery is generally not performed during acute tonsillitis, but only after the inflammation has subsided for 3-4 weeks.
(2) Hematologic disease, compensated heart disease, active tuberculosis, etc. are contraindicated.
(3) Surgery is not recommended when systemic symptoms such as rheumatic fever and nephritis are not controlled.
(4) Surgery is temporarily contraindicated in poliomyelitis and influenza.
(5) Patients with immunoglobulin deficiency or high incidence of autoimmune diseases in their family members. Those with a white blood cell count below 3000.
(6) Tonsils should not be removed if there are only a few cases of tonsillitis.
Surgical method
General anesthesia tonsil peeling method
1.Take a supine position and open the mouth with a mouth opener so that the pharynx is clearly exposed. Inject 1% procaine plus 1:1000 epinephrine under the mucosa of the lingual-palatal arch and pharyngeal-palatal arch to stop bleeding. The procedure is performed in the same way as local anesthesia tonsil removal. However, the patient’s head position is inverted, so the direction of surgery is opposite to that of local anesthesia.
2. Attention should be paid to keep the airway open at all times during the operation to prevent asphyxia. Hemostasis should be thorough to prevent postoperative bleeding.
3.After tonsil removal, it is advisable to scrape the proliferator with a proliferator resector and proliferator dissection spoon at the same time and stop bleeding with yarn ball compression.
How old is a child suitable for tonsillectomy
The protective function of the tonsils is generally considered more important in children under the age of 3. Unless frequent tonsillitis or overly enlarged tonsils are seriously damaging the child’s health, it is best to wait until after the age of 3. This will be decided after a consultation between a pediatrician and an ENT surgeon, who will weigh the pros and cons.
What is the best season for surgery?
Parents generally think that summer is the best choice, but in fact, the temperature inside the mouth is around 37°C all year round, so there is no need to consider the problem of wound infection. As for the summer surgery more people, often parents to give more ice cream as “bait”, to persuade children to accept the surgery. The fact that you must eat cold drinks after surgery is also a misconception, although cold drinks may play a role in relieving pain and stopping bleeding, but it is not necessary to eat, not to mention more, too much cold drinks are not good for the stomach, but only in moderation. In addition, surgery can only be performed one month after the acute tonsillitis has subsided, and those with systemic diseases should also undergo surgery only after proper adjustment and preparation when their condition is in a stable phase.