A tonsillectomy is the surgical removal of the tonsils, the two pads located at either side of the back of the throat. The tonsils serve as part of the immune system, a first line of defense for pathogens entering the mouth or nose. Because of their function, they may become infected or inflamed and, in some cases, may require surgical removal. Tonsillectomies are more commonly performed on children than adults. A tonsillectomy may be necessary when an individual has recurring episodes of tonsillitis or an ongoing infection that has not healed with other treatment. Surgery may also be required if enlarged tonsils block airways, leading to sleep apnea, swallowing problems or difficulty eating. Rarely, a tonsillectomy may be performed to treat a malignancy of the tonsils.
Traditionally, tonsillectomies have been performed with a scalpel under general anesthesia during a procedure which usually takes approximately an hour. In recent decades, many types of surgical procedures have become available for use in tonsillectomies. General or local anesthetics may be used, depending upon the method employed. Most patients return home several hours after the operation and are expected to heal within about 2 weeks.
Cold Knife Dissection
During a cold knife tonsillectomy, the doctor uses a snare, a knife curved like a circle, to remove the tonsils. This method requires general anesthesia, and approximately 2 weeks of recovery time.
Using the electrocautery method, the surgeon burns the tonsillar tissue, stemming blood loss through cauterization. While this technique greatly reduces the risk of excessive bleeding, research has shown that the heat employed can damage surrounding tissue and may lead to a more painful recovery.
During a coblation tonsillectomy, radio waves are used to ionize a saline solution, energizing the ions enough to enable them to cut through tissue and remove the tonsils. Because this procedure is performed without heat, less postsurgical pain and more efficient healing has been reported.
This technique is used for a partial tonsillectomy. The microdebrider is a powered rotary shaving device with suction, eliminating the enlarged portion of the tonsil while preserving some tonsillar tissue. A natural biologic dressing is placed over the tonsil in order to prevent inflammation and infection. This procedure has been shown to result in less pain, dehydration and bleeding and a more rapid recovery. Because this procedure leaves part of the tonsil intact, however, it is recommended as a treatment for enlarged tonsils rather than infected ones.
In this technique, ultrasonic vibrations are used to simultaneously cut tissue and cauterize the wound. An advantage of this technique is minimal damage to the surrounding tissue since sound waves, rather than heat, are responsible for excision.
During laser ablation, a handheld laser device uses carbon dioxide to cut and destroy the tonsillar tissue. This technique reduces tonsil volume and eliminates recesses that collect recurrent infectious bacteria. This procedure is recommended for chronic sufferers of tonsillitis, chronic sore throats, severe halitosis, or airway obstruction caused by enlarged tonsils. The laser tonsil ablation is performed in 15 to 20 minutes under local anesthesia. The patient may experience minimal discomfort and may return to school or work the next day.
Some types of tonsillectomy procedures result in shorter recovery times and less postsurgical soreness, but not all types of surgery are appropriate for all patients.
Risks of a Tonsillectomy
Although a tonsillectomy is a safe procedure, there are risks involved in any surgery. While a painful sore throat and some bleeding are expected after a tonsillectomy, more serious complications, though rare, may occur. These include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Postsurgical infection
- Breathing problems
While a tonsillectomy will greatly reduce the number of throat infections, it is possible for throat infections to recur after surgery. Additionally, the tonsils may partially grow back after a tonsillectomy, especially if some tonsillar tissue is left at the site.