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Tonsil Problems
Tonsillectomy (usually with adenoidectomy) is one of
the most commonly performed surgeries in the United
States today, especially in children. While tonsillectomy
is often considered a "routine" operation,
it is never routine for the parents and the child undergoing
the procedure. It can be a scary time for all, and postoperative
pain can be a major challenge. Furthermore, like any
procedure, there are risks and complications possible
with this operation.
We
at Louisville ENT Associates are aware of these issues,
and strive to make tonsillectomy as tolerable and risk
free a procedure as possible for parents and child alike.
Our physicians utilize the most current techniques to
remove the tonsils and to assist in recovery. While
we cannot prevent all complications and pain, it is
our goal to minimize these as much as is possible. Fortunately,
in most of our patients this goal is realized. The majority
of children and parents report a very mild and tolerable
post operative course.
The
operation of tonsillectomy is usually done as an outpatient
procedure, although sometimes overnight stay is required.
The patient will be brought to the operating room and
placed under an anesthetic, the tonsils will be removed,
and then the patient will be brought to the recovery
room to be monitored. Once the child is stable and adequate
post operative observation completed, the patient is
sent home (unless a previous arrangement for 23 hour
stay has been made).
There
are a number of techniques available for tonsillectomy.
While this is certainly not an exhaustive list of all
techniques, this is a list of some of the more common:
1.
Sharp dissection . Refers to any technique of removal
where the tonsil is removed with scalpel or scissors,
and bleeding controlled later. Frequently the tonsil
is snared and removed at the base. PROS = oldest
technique, most MDs trained in this technique. CONS
= more blood loss, use of much cautery, no improvement
in post operative pain. BOTTOM LINE = historic
technique that has limited application currently.
2. Bovie dissection. Technique of using an electrocautery
to remove the tonsils. An electrocautery is a device
that creates heat by the use of electric currents. It
will cauterize (control bleeding) as it cuts. PROS
= commonly used amongst MDs, easy to accomplish,
little to no bleeding. CONS = more pain after
surgery, can bleed 5-7 days later. BOTTOM LINE =
effective technique although postoperative pain leaves
something to be desired.
3. Needle Bovie dissection. Similar to #2 above,
but a fine tip needle dissector is used to do the dissection.
Allows for lower energy and heat amounts to be used.
PROS = Effective like #2 but since less heat
energy is required there is less postoperative pain.
CONS = still can have problems with postoperative
discomfort. BOTTOM LINE = Better than #2 for
pain, effective.
4. Harmonic Scalpel dissection. Utilizes the
Harmonic Scalpel, which is an ultrasonic vibratory device,
to remove the tonsil. The ultrasonic frequency generates
heat energy, which removes the tonsil. PROS =
excellent for control of bleeding and diminished post
operative pain. CONS = more time consuming, added
expense. BOTTOM LINE = added expense well justified
with reduction of post operative pain and quicker return
to normal diet
After
tonsillectomy we recommend the child drink as much clear
liquid as possible. This can be in the form of sweetened
drinks, water, popsicles, and Jell-O. Other soft foods
are O.K., but should be supplemented with plenty of
fluids. Avoid carbonated, caffeinated, and citric drinks,
as they can burn the throat. Avoid crunchy foods as
they can scrape the throat and may precipitate bleeding.
This
information is intended for general information only,
and is not a substitute for discussions with your doctor.
We would be happy to discuss you child's throat problems,
and the possible need for tonsillectomy, with you at
our office. Any of our 4 physicians will be glad to
evaluate and treat you for these problems!
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