Introduction
Tonsils are small, oval-shaped soft tissues present at the backside of the throat. These play an essential role in providing immunity because they are made from lymphoid tissues made of white blood cells. The peritonsillar space between the surrounding muscles of the tonsils and fibrous capsule is highly susceptible to bacterial infections. Therefore, infection and inflammation of the tonsils are common among people, especially children.
Sometimes, children suffer from sleeping disorders in which their sleeping pattern becomes abnormal and results in snoring. When children suffer from such sleep disorders and recurrent infections of the tonsils, surgically removing the tonsils is the best treatment option. This procedure is called a tonsillectomy, which is done with or without removing adenoid glands (a type of tonsil).
What Is Tonsillectomy?
It is a surgical procedure to remove the tonsils altogether. It is done with adenoidectomy or sometimes without it. Tonsils are oval-shaped soft tissues present at the backside of the throat.
What Is Adenoidectomy?
It is the surgical removal of adenoids that have become infected and swollen. Adenoids are soft tissues present at the backside of the nose. When they become inflamed and swollen, they cause breathing difficulties.
What Is the Function of Tonsils and Adenoids?
Tonsils and adenoids are responsible for providing immunity because they kill the bacteria that enter through the nose and mouth.
What Are the Different Types of Tonsils?
There are three types of tonsils:
- Palatine Tonsils - Present at the right and left side of the throat.
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Adenoids - Present at the back of the nose.
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Lingual Tonsils - Present at the tongue base.
What Are the Anatomical Structures Involved in Tonsillectomy and Adenoidectomy?
As mentioned above, all three types of tonsils make Waldeyer’s ring, which contains lymphoid tissues. The lymphoid tissues are made of white blood cells that provide immunity. Muscles surround the tonsils, and a fibrous capsule is present between the muscles and lymphoid tissue. The space between the fibrous capsule and surrounding muscle is called peritonsillar space.
The muscles surrounding the tonsils are palatoglossus, superior constrictor muscle, and palatopharyngeal muscle.
The tonsils receive the blood supply from various blood vessels. However, the glossopharyngeal nerve is present in the depth of the surrounding muscles. During a tonsillectomy, this nerve is most likely to get injured. The other blood vessels that supply to the tonsils are the lingual artery, facial artery, ascending pharyngeal artery, and others.
What Are the Indications of Tonsillectomy and Adenoidectomy?
The most common indications are:
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Sleep-Disordered Breathing in Children: It is a severe condition in which the patient's respiratory pattern or breathing pattern becomes abnormal. This results in snoring, stopping, and starting breathing repeatedly.
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Recurrent Tonsillitis in Children: It is the inflammation of the tonsils, due to which the tonsils become swollen and tender. It also results in fever and sore throat. When palatine tonsils become inflamed, the patient suffers from breathing problems and sleeping problems.
Other indications are:
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Malignancy or cancer such as lymphoma and squamous cell carcinoma. It causes an asymmetrical appearance of the tonsils.
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Peritonsillar abscess. The peritonsillar space is the most common area for bacterial infections and pus formation.
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Periodic fever due to tonsil infection.
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Pharyngitis (the inflammation of the pharynx).
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Adenitis (the inflammation of the adenoid gland).
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Ear infection in the children. This may interfere with a child's learning abilities and education.
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Blockage of the airway in children because of swollen adenoid glands.
Based on the clinical practice guidelines from the American Academy of Otolaryngology, tonsillectomy and adenoidectomy indications are:
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Frequently occurring throat infection. Seven episodes in the last year or five episodes in the previous two years.
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The doctor should monitor recurrent throat infections if there are less than seven episodes of infection within one year or less than five episodes in the previous two years, or less than three episodes in the last three years.
What Are the Contraindications of Tonsillectomy and Adenoidectomy?
Given below are the contraindications:
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Bleeding diathesis (an abnormal condition in which the patient becomes vulnerable to bleeding or bruising).
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Medical illness.
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Anemia (characterized by lower levels of hemoglobin in the blood).
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Short-term or acute infection of tonsils.
Which Age Group Most Commonly Undergo Tonsillectomy and Adenoidectomy?
Children below the age of 15 years commonly undergo tonsillectomy with or without adenoidectomy. However, anyone with severe conditions such as cancer or recurrent infection may undergo a tonsillectomy.
How Are Tonsillectomy and Adenoidectomy Done?
The procedure is performed through different methods. Commonly used methods are:
1) Hot Tonsillectomy: The tonsils are removed through electrocautery. In this technique:
- Electric current is passed through an electrode or a rod. The current is of high voltage and high frequency.
- The active electrode is placed at the surgery site or the tonsil area.
- Another electrode is placed at another location on the patient’s body. In this way, an electric circuit becomes complete, and the patient becomes a part of the circuit.
- The tonsils are then cut and removed.
- The incision is packed and closed with a dressing.
2) Cold Tonsillectomy: In this technique:
- The tonsils are held firmly with special clamps called Allis clamps.
- An incision or a cut is made on the lateral side of the tonsils.
- Special scissors called Metzenbaum scissors are used to cut the tonsils.
- The incision is packed and closed with a dressing.
What Are the Complications of Tonsillectomy and Adenoidectomy?
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Bleeding after surgery is most commonly reported. It is more commonly seen during the nighttime in children.
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Nausea and vomiting. This may occur when the child is not given antiemetics during the treatment.
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Difficulty swallowing occurs because, after the removal of the tonsils, the patient may feel pain during swallowing.
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The patient loses weight because of decreased food intake and vomiting, which leads to dehydration.
Conclusion
Tonsillectomy is the most common surgical procedure performed mainly in children. It is indicated for two commonly occurring reasons, such as sleeping disorders and recurrent infection and inflammation of the tonsils. There is no definite contraindication of tonsillectomy and adenoidectomy. However, it should not be performed on those patients who have another medical illness that is uncontrollable, like bleeding disorder and anemia. Pain after tonsillectomy majorly causes the death of the patient. Therefore, it is important to identify the appropriate situations where tonsillectomy is indicated.
