Tonsillectomy (Tonsil Removal Surgery)

Tonsillectomy Operations

What is tonsillectomy?

 Tonsil removal surgery (tonsillectomy) is the operation of removing the tonsils (tonsilla palatina, palatine tonsils) in our throat, which are the Waldeyer lymph node ring element. There are many different devices and techniques used to remove tonsils. Tonsillectomy surgery is performed under general anesthesia in almost many clinics.

 Tonsillectomy Techniques

Tonsil surgery was first performed by the Roman surgeon Celsus and he described a technique in the tonsil tissue as tearing, pulling with a hook and cutting with a scalpel.

 Today, many tonsil surgery techniques have been defined and still many surgeons can use a scalpel during tonsil surgery. Tonsil surgery techniques can be listed as follows:

 - cold knife technique

 It is the process of removing the tonsils using a scalpel. This technique is especially applied in young patients and under general anesthesia conditions. Although post-operative recovery is fast, the risk of bleeding may be high.

 - Electrocautery assisted tonsil surgery

 Electrocautery burns the tonsil tissue and separates it from the outer tissue. This technique causes less blood loss than the cold knife technique. However, it may cause thermal damage to tissue other than tonsils. After the surgery, pain may be more due to heat damage.

 - Harmonic scalpel technique

 This medical device is in the form of a blade with 55,000 vibrations per second with ultrasonic energy. No blade vibration with bare force. The vibrational energy cuts the tissue and also helps to stop (coagulate) bleeding.

 - Ablation with radiofrequency (somnoplasty)

 By using monopolar radiofrequency, tonsil tissue can be reduced under local anesthesia and office conditions. There are opposing opinions that there may be pain in this method and there may be small abscess areas within the badger.

 - Laser tonsil reduction (laser tonsil ablation)

 Carbon dioxide laser or KTP laser can be used to vaporize and shrink the tonsil tissue. This procedure is recommended for chronic recurrent tonsillitis, chronic sore throat, severe halitosis or airway obstruction caused by enlarged tonsils. In case of laser-induced mucosal burn, severe pain can be seen.

 - Microdebrider assisted tonsil reduction

 A microdebrider is a medical device with a rotating tip that also creates a vacuum. Tonsil tissue can be shaved with the help of endoscopic method and microdebrider. Since the cut tonsil tissues are left behind, there is a risk of bleeding after the surgery.

 - Coblation method

 The coblation device creates an ionized salt layer that breaks molecular bonds without the use of heat. This mechanism can be used to remove all or only part of the tonsils. Although it is advocated that less pain and less care is required after surgery; It is emphasized that there is a risk of late bleeding in this method.

 - Thermal welding method (bloodless, bladeless tonsillectomy technique)

 "Starion Thermal Welding System" works with the latest developed thermal welding technology, which causes the least heat damage to the environment. In this system produced by Starion Company, the heat energy produced at the tip of the probe can be used in two different modes. In the first mode, the veins in the tissue are contracted and the tissue is cut so that the heat conduction to the second environment is minimal. Link where you can find information about the device and probes >> Starion Instruments « Elite Healthcare - http://elitehealthcare.biz/blog2/our-products/starion-products/

Is it possible to smoke after tonsil surgery?

After tonsil surgery, the air space is widened as the bilateral tonsil tissues are removed in the pharynx region. They continue to serve in the adjacent areas (tongue tonsil, lateral pharyngeal bands, adenoid, lymph nodes in the neck and under the chin) instead of the diminished lymphatic tissue. In the case of smokers without tonsils, foreign particles in cigarette smoke, soot and soot residues may adhere to the pharynx and cause "recurrent pharyngitis attacks" and "chronic pharyngitis" over time. If you do not have tonsils, you should stay away from cigarette and hookah smoke and not smoke. Smoking after tonsillectomy will have many harmful effects in the short and long term. Drinking herbal tea after smoking, using antiseptic mouthwash or doing sports does not fully protect you. "When to smoke after tonsil surgery?" one of the most difficult questions to answer ... If you do not have tonsils, do not do this evil to yourself and do not smoke if possible. After tonsil surgery, full recovery usually takes 2-4 weeks, depending on the technique used and the care of the patient. The highest risk of bleeding and infection is in the first 10 days after tonsillectomy. "Is smoking after surgery?" As an answer to the question, I would like you to consider the many negative effects that smoking can cause after surgery. After tonsillectomy, if you have a healthy nose, that is, if you breathe air through your nose regularly, the inhaled air is heated, humidified, purified and pressurized, and transmitted to the lower respiratory tract and then to the lungs. After tonsil surgery, smokers may also have a tendency to dry throat and pharyngitis indirectly as a result of swelling in the nasal concha and increased nasal congestion. Carbon monoxide and nicotine in the content of cigarettes have negative effects on tissue nutrition.

If your nose is clogged, you do not have tonsils, and you have a job that requires you to talk all the time (causing a dry throat), the negative effects mentioned above can be seen much more in case of smoking.

Can alcohol be consumed after tonsil surgery?

It is inconvenient to use alcohol in the early period after tonsil surgery. Consumption of alcohol-containing beverages in the early period after tonsillectomy may increase the risk of bleeding after surgery and delay wound healing, due to the vasodilating property of alcohol and its negative effect on wound healing with long-term direct contact. "How many days after the operation alcohol is taken?" In answer to the question, "Alcohol can be taken after the whitish color of the first healing tissue in the tonsil bed is completely replaced by the normal pink intraoral mucosa". This period (tonsil surgery recovery period) can vary up to 2-4 weeks depending on the diet and the tonsil surgery technique used. Generally, when the thermal welding tonsillectomy technique is used and the patient consumes fluids at frequent intervals, almost complete recovery can be achieved in 2 weeks. It should be kept in mind that there may be large veins or vascular networks separated from the jugular veins in the outer part of the pit where the tonsils were taken, and the risks of touching alcohol to this area. "The comments of those who have had tonsil surgery" are generally that after the first 10 days, many complaints have almost disappeared.

When does the pain go away after tonsil surgery?

The less heat damage is done to the mucous and muscle layer outside the tonsils during tonsil operations, the less the amount of pain and duration of pain that the patient can feel after the surgery.

Links where you can find information about recommendations that accelerate recovery after tonsil surgery (post tonsillectomy nutrition recommendations - tonsillectomy diet) and some practical applications that can be done during surgery >> Nutrition to Accelerate Recovery After Tonsil Surgery ...

It is reported by many patients after tonsillectomy that the pain increases after the dryness of the throat, which increases due to not drinking water during sleep at night, and this pain is felt most in the first few days after the surgery. In order to avoid mucosal damage during the operation, the use of devices that use heat energy as little as possible, rinsing the patient's throat with cold sterile serum during the operation, applying serums containing cortisone and painkillers during the operation can reduce the amount of pain felt by the patient. In patients who usually drink water regularly and eat protein-containing foods, the pain decreases considerably after the 10th day. For those who have tonsil surgery, the first 10 days mean a much more comfortable and less painful period. Paying attention to the care recommendations of the patients after tonsillectomy is also effective in accelerating the recovery as much as the surgical technique.

The use of devices that reduce heat damage, blood loss and pain, such as thermal welding, increases the comfort of the patient after surgery.

What Causes Pain After Tonsil Surgery?

During tonsil surgery, more or less damage occurs in the muscle and mucous tissues outside of the tonsils. Especially in the surgical method using classical bipolar, heat damage can occur with temperatures of 300-400 degrees. In the method known as "Thermal Welding Method", heat damage and thus post-operative pain are minimized. Apart from the tonsil pit, there is a muscle group that also takes part in the swallowing function. Apart from heat damage, injuries that may occur in these tissues and other mucosal areas can also increase the amount of pain.

The Importance of Oral Nutrition After Tonsil Surgery

Although pain may occur after tonsil surgery; Oral intake of soft watery foods and continuous washing of the surgical area, keeping the body water level high accelerate the healing. Especially in patients who do not consume watery food by mouth due to pain, a vicious circle process may occur such as an increasing sore throat and gradually increasing nutritional restriction.

Which Foods Are Inconvenient to Eat After Tonsil Surgery?

It is inconvenient to eat hard, hot, sharp-edged, acidic, salty and extremely spicy foods after tonsil surgery. Such foods may cause damage to the mucosa and adversely affect the healing; Hot foods can cause widening of the vessels and the onset of bleeding.

What is the Riskiest Period for Bleeding After Tonsil Surgery?

The first 10 days after tonsillectomy is the most risky period in terms of bleeding. Bleeding is more common on the 10th day, especially because of the change in the collagen structure on the 10th day. For this reason, nutrition and care for the first 10 days is very important.

How to Feed After Tonsil Surgery?

Frequent oral intake of soft and warm foods with high protein content accelerates healing (such as broth soup, bone marrow soup, ayran, kefir, yoghurt, etc.) after tonsillectomy.

Drinking water frequently will also keep the surgical field moist. For example, drinking half a glass of water every half hour (at night, getting up and drinking water at a timed hour can also speed up recovery).

Especially on the 3rd day and a few days after the operation, earaches may begin after the drying of the throat during sleep at night. Drinking water late or running a cold steam machine can reduce this.

Chewing gum can help wash the throat passages with saliva, which is an antiseptic secretion, and accelerate healing.

Eating ice cream and cold milk desserts on the first day after tonsillectomy can also reduce pain.

How long does tonsil surgery take?

Tonsil surgery can be completed within 5-10 minutes when it is performed using old-style devices that convert electrical energy into heat energy. However, when applications that prolong the time I have listed below but reduce the patient's pain and other complaints after surgery are performed, the time may extend up to 45 minutes:

- duplicating the folds in the front and back of the tonsils with soluble suture materials (prolongs the time like an additional 15 minutes)

- Reducing tongue pressure by occasionally loosening the metal retractors in the mouth

- washing the surgical field with cold serums during the operation

- applying local anesthetic mixed with serum to the tonsil bed (causing numbness for up to 4 hours and some foreign body sensation)

- intravenous administration of cortisone-containing products such as dexamethasone during surgery

- Less use of the caustic mode of the thermal welding device and as little cauterization as possible to the bleeding areas (it can cause localized burn damage over 300 degrees)

Bloodless, bladeless tonsil surgery (Thermal Welding Tonsillectomy)

Below, you can watch the videos of bloodless and bladeless tonsil surgery performed with the thermal welding device. Although this method is introduced with the words "bloodless, knifeless and painless tonsillectomy", which means "bloodless, knifeless and painless tonsillectomy" in some foreign health sites; To claim that it is completely painless and completely bloodless seems a bit of an exaggeration.

Tonsillectomy Operation Videos:

Is it possible to gain weight after tonsillectomy?

I would like to share a few different information about weight gain after tonsil surgery. If it is done due to recurrent tonsillitis attacks, especially after tonsillectomy in children, general well-being, decrease in infection symptoms and increase in appetite occur. It is appropriate not to give artificial and high glycemic index foods to children after tonsillectomy. There are different scientific studies on post-operative weight gain, especially in children who underwent tonsillectomy + adenoid surgery together (adenotonsillectomy operation). Studies have indicated that adenotonsillectomy may be associated with significant post-operative weight gain, a problem that can arise for both parents and patients. 

Previous research has also suggested that postoperative weight gain associated with adenotonsillectomy occurs mostly in children undergoing the procedure as treatment for diagnosed obstructive sleep apnea (OSA). Potentially alarming weight gain following adenotonsillectomy occurred primarily in children younger than 6 years of age who were overweight or normal weight at baseline. The underlying causes of weight gain after adenotonsillectomy are still unknown for these patients, but more research is needed (source link >> Key Factors in Weight Gain After Pediatric Tonsillectomy).

Children who have their tonsils removed show a tendency to gain weight after surgery, according to an analysis of studies over the last 40 years. While new research does not prove whether there is a direct link between tonsillectomy and weight gain, the growing obesity epidemic around the world is primarily due to lifestyle. In underweight or overweight patients, calorie restriction after tonsillectomy is beneficial (source link >> Tonsil Removal May Lead to Weight Gain - WebMD).

Researchers from the Johns Hopkins University School of Medicine found that weight gain after tonsillectomy is most common in children aged 6 years and younger, especially those who were underweight or normal weight at the time of the procedure (ie, the patient does not have to be overweight beforehand!). Apart from that, in the same study, the researchers emphasized that more research is needed to determine how child age affects weight gain after tonsillectomy (source link >> Younger Kids Likelier to Gain Weight After Tonsillectomy - MedicineNet).

Many families have a question, "Does tonsil surgery make you gain weight?" It seems impossible to answer the question easily. However, many sources emphasize that families should not worry about this issue and that it will be sufficient to pay attention to the diet of the patients if necessary (source link >> Weight gain in children following tonsillectomy. - NCBI)

How many days does tonsil surgery heal?

Full recovery time after tonsillectomy can vary between 1-3 weeks, depending on the technique used and the care of the patient. In fact, the healing process of tonsil surgery varies according to the mucosal irritation and burn damage in the patient's mouth during the surgery, and the patient's diet. In case the operation area has little contact with water and dries up, the recovery time is prolonged in case of dehydration (dehydration).

Tonsil surgery in adults

The most frequently asked questions about tonsillectomy operation in adult patients are about "tonsillectomy over 30 years old", "tonsillectomy at 30 years old" and "tonsillectomy at 40 years old" and interestingly, there is no special case for tonsillectomy at 30 and 40 years old. 😊.

In children with frequent sore throats or snoring, tonsil removal may be planned. However, tonsillectomy surgery is not just for children. Adults may also need this surgery.

It is done the same way in children and adults, but the risks and recovery for an adult may be different.

Risks and possible complications of tonsil surgery in adults

Tonsillectomy surgery is considered a safe procedure for adults. However, all surgeries have risks. In a 2014 report, it was emphasized that the following risks and complications could be seen in 1 in 5 adults whose tonsils were removed:

• Dehydration

• Infection

• Pain

• pneumonia

• Excessive bleeding from the wound (bleeding)

These risks and complications are less likely to occur if techniques that reduce mucosal damage and minimize heat dissipation are used, and if the patient follows appropriate care recommendations (source link >> Can an Adult Need a Tonsillectomy? - WebMD).

A few different features between tonsil surgery in children and tonsil surgery in adults:

• Children usually recover faster than adults.

• After the tonsils are removed in children, the possibility of bleeding problems is low.

• Adults tend to have more pain after surgery. This may be due to the fact that adults try to return to work very early after surgery, less adherence to recommended instructions, and different recovery characteristics. In children, the more serious application of the parents' healing instructions can also be effective in the difference in recovery speed.

Tonsillary hypertrophy

At the beginning of the symptoms of tonsil enlargement, the decrease in sleep quality, difficulty sleeping on the back, the feeling of being stuck in the throat, and the aggravation of sleep apnea symptoms come. In fact, tonsil and adenoid enlargement are among the causes of sleep apnea syndrome, especially in children. Above is an intraoral examination photograph of a child with large tonsils. It is seen that the uvula between the tonsils is edematous (there is also a slightly bifurcated appearance at the tip of the uvula). Because of the large tonsils in adults, sleep apnea symptoms may occur. As the intraoral airway cross-sectional area decreases, it is inevitable that the amount of air that the patient can take during sleep and therefore the amount of oxygen decreases. For the treatment of large tonsils, there are treatment options such as partial removal of the tonsils (partial tonsillectomy), reduction of the tonsil tissue with radiofrequency or laser, or complete removal of the tonsils with bloodless and modern techniques. Many patients ask, "How to reduce a large tonsil?" As an answer to the question, there is no medical treatment or herbal medicine that allows the structurally large tonsils to shrink in volume. Antibiotic and antiseptic throat rinses used in acute tonsillitis do not have a shrinking effect on the structurally large tonsils. The answer to the question "How can a large tonsil get smaller is herbal?" "Should a large tonsil be removed?" As an answer to the question, "If there are no symptoms due to large tonsils (hypertrophic tonsils) or tonsillar size (tonsillar hypertrophy)", it is not necessary to remove the tonsils. However, if there are symptoms such as sleep apnea, frequent tonsillitis, the tonsils should be removed under the follow-up of an ENT specialist. can be decided”.

There are many scientific studies that emphasize that heart and lung diseases can be seen due to enlarged tonsils and adenoids, or that the patient may become more prone to hypertension in the long term. Links to some of these studies (this information has been emphasized since the 1960s) >> Heart failure due to enlarged tonsils and adenoids. The ... - NCBI / Tonsillar hypertrophy, airway obstruction, alveolar hypoventilation ... / Effect of adenotonsillar hypertrophy on right ventricle function in children / Adenotonsillar Hypertrophy as Cause of Pulmonary Hypertension / Enlarged Tonsils and Fatigue

Unilateral tonsil hypertrophy

Sometimes the position of the tonsils in the mouth may be different and one of them may be closer to the midline. If there is an asymmetric tonsil position for a long time, there is nothing to be afraid of. However, if a tonsil grows gradually without causing pain or other complaints, and there is a gradual increase in size difference on one side, the patient should be evaluated by an ENT specialist and a biopsy or biopsy if necessary. Unilateral tonsillectomy may be required for treatment. If there is no change in size and shape in patients with asymmetric tonsils, a good study link showing that the probability of a cancerous focus is very low >> Is unilateral tonsillar enlargement alone an indication for tonsillectomy?

Study link emphasizing the need for tonsil surgery in patients with unilateral tonsillar enlargement, in case of progressive increase in unilateral tonsil enlargement, additional lymph node enlargement in the neck and the addition of systemic symptoms >> What is the best management of asymptomatic unilateral tonsillar ...

If the tonsils are removed, will the disease frequency increase?

The tonsils are two of the lymphoid tissues found in the oral cavity. There is a tonsil on either side of the back of the mouth, they are located on either side of the uvula. Because they are lymphoid tissue, they are involved in immune function. There is a lot of other lymphoid tissue in the head and neck, so our immune system is not entirely dependent on the tonsils for defense against bacteria and viruses. No studies show an increase in the frequency of upper respiratory tract infections when the tonsils and adenoids are removed (source link >> Tonsillectomy in Children and Adults: Recovery & Complications ...).

Food list after tonsil surgery

After tonsil surgery, all hard and hot, sharp-edged, non-spicy foods (roughly soft warm foods) should be consumed.

At the beginning of the nutritional recommendations after tonsil surgery, products with high protein content such as boiled meat and cereal products, boiled and cooled bone marrow or chicken broth soups, dairy products, and yogurt, and products such as ayran and kefir.

Just as it is inconvenient to contact a cut skin area with salt, hot spices, boiling products or a sharp object, it is also inconvenient not to touch the surgical area in the throat after tonsil surgery. Tonsillectomy instead of special care in the form of nursing care; It is sufficient to pay attention to the special diet.

Speech after tonsillectomy

After tonsil surgery, the airway cross-sectional area in the throat increases. For this reason, the shaping (resonance) of the voice after the vocal cords may change, and families may tell us that there is a different tone of voice in the first few weeks and a different tone afterward, especially in children with large tonsils.

Risks of tonsil surgery

Tonsillectomy, like other surgeries, has some risks. The risks of tonsillectomy operation can be summarized as follows:

• Anesthesia-related risks: Medications that make you sleepy during surgery often cause minor, short-term problems such as headaches, nausea, vomiting or muscle pain. Serious, long-term problems are rare.

• Swelling of the lip and soft palate: it can cause respiratory problems, especially during the first few hours after the procedure.

• Bleeding during surgery: In rare cases, severe bleeding occurs during surgery and additional treatment and hospital stays may be required.

• Bleeding during healing. Bleeding may occur, especially if the healing tissue from the wound is expelled very quickly by coughing.

• Infection: Rarely, surgery can cause an infection that requires further treatment.

 Atlantoaxial subluxation, mandibular condyle fracture, which I have only seen in publications and have never encountered before, are also written as a risk of tonsil surgery.

Long-term chronic pharyngitis can be written as the harms of tonsil surgery, especially in patients who smoke and have to talk constantly.

Tonsillectomy complications have become quite rare nowadays (source links >> Tonsillectomy Risks - Mayo Clinic / Complications of tonsillectomy and adenoidectomy. - NCBI / Complications of tonsillectomy: a comparison of techniques. - NCBI).

Tonsil surgery age

In old sources, it is written that tonsil surgery should not be performed under the age of 3 years. It was emphasized that care should be taken especially in children with large tonsils and narrow airways. Today, although it is recommended to wait until the age of 3 unless there is a necessity; Generally, tonsil surgery can be performed after 2 years of age. It is appropriate for younger children to be operated on in fully equipped hospitals. "Can a 2 year old have tonsil surgery?" As an answer to the question, tonsil surgery can be performed in a good hospital if necessary.

Although there are many reports claiming that tonsillectomy increases postoperative morbidity and mortality in patients under 3 years of age; There are also studies emphasizing that tonsillectomy can be performed safely among young children (source link >> Tonsillectomy under the age of 3 years: is it recommended or not ...).

How old is the tonsil surgery at the latest?

Although there is no age limit for tonsil surgery in adult patients; It is more appropriate not to have tonsil surgery in patients who cannot bear the risks of general anesthesia and surgery, and those who use drugs that cause surgery to be inconvenient.

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Dr. Murat Enöz - MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:

Address: İncirli Cad., No:41, Kat:4, Dilek Pastanesi Üstü (Dilek Patisserie Building), Posta kodu: 34147, Bakırköy - İstanbul

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E-mail: muratenoz@gmail.com

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Fax: +90 212 542 74 47