Tonsillectomy Operation in Istanbul

Tonsil Removal Surgery



The tonsils are two lymphoid tissues that located on both sides of the back of the throat.
Tonsillectomy is a surgical procedure performed to remove the tonsils.

Tonsil surgery is a surgical procedure performed for nearly 3,000 years. Infections, such as sleep apnea and cancer diagnosis can be so many different reasons, depending on. All the world in the last 30 years has increased the frequency of tonsillectomy. This is because, with the size of the tonsils of the relationship between sleep apnea syndrome is to be understood clearly.

Structure and Tasks of Tonsils

Structure and Tasks of Tonsils

Tonsils (tonsilla palatina) are the lymphoepithelial organs in the mouth, oral cavity and oropharynx junction. It is strategically positioned to serve as secondary lymphoid organs that promote the immune responses to antigens entering the body through the mouth or nose. Tonsils have the highest immune activity, especially in children aged 3-10 years. After the age of 10, the tonsils decrease in function and shrink spontaneously.

Although almost all 5 types of antibodies are produced in tonsils; IgA antibody is the most important antibody in defense of the germs produced by tonsils. The epithelial cells, particularly on the outer part of the tonsils, contribute to the production of IgA antibody.

Because tonsils are an element of the immune system and have these defense tasks against germs, it affects the decision of tonsillectomy.

Especially in children with large tonsils, sleep apnea (sleep apnea) occurs, taking tonsils have been shown to be more beneficial in terms of health.

The new tonsillectomy guide recommends that families, nursery and nursing home staff be informed about sleep breathing disorders in children and that children are evaluated for tonsil and, if necessary, by an ENT specialist in case of respiratory arrest or near-stopping.
Source: Clinical Practice Guideline Tonsillectomy in Children - http://oto.sagepub.com/content/144/1_suppl/S1.long

When tonsils are removed, does the infection easily spread to the body?

When tonsils are removed, does the infection easily spread to the body?

Sometimes we hear the comments expressed by the families that enfeksiyon when the tonsils are taken the infections spread to the body ve and "the tonsils are the body's guarantee against the germs". It is certain that tonsils are an element of the immune system and actually play a role in the fight against microbes. However, when tonsil surgery is performed, the benefits and damages of these tissues to the body are evaluated. Risk and negative features related to recurrent tonsillitis, drug use, sleep apnea also lead physicians to perform tonsillectomy.

So far, there has been no study showing that the body's donation system is seriously affected after tonsillectomy (link to a comprehensive article on the subject: Impact of Tonsillectomy Clinical Practice Guidelines -  http://oto.sagepub.com/content/147/2_suppl/P232.4.short).

About postoperative pain and thermal welding tonsillectomy

About postoperative pain and thermal welding tonsillectomy


Tonsil surgery is performed under general anesthesia and the procedure takes approximately 15-20 minutes according to different techniques. Bleeding during surgery and postoperative pain are less with the Thermal Welding method.




Tonsillectomy Indiciations

Tonsillectomy in Istanbul - Tonsillectomy Indiciations - Tonsillectomy Contraindications - Tonsillectomy Risks and Complications - Tonsillectomy Techniques - Surgical Procedure - Postoperative Patient Care After Tonsillectomy Operation - Tonsil Removal in Istanbul - Bloodless Tonsillectomy - Thermal Welding Tonsillectomy

This topic were discussed in detail on the last "Clinical Practice Guideline : Tonsillectomy in Children - https://www.entnet.org/sites/default/files/CPG-TonsillectomyInChildren_0.pdf".

Tonsillectomy Operation in Istanbul
According to the latest guideline published by the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS) on tonsil surgery, the situations where tonsil surgery is absolutely necessary and the relative requirements are summarized as follows:

Clinical indications for tonsillectomy operation are as follows:

Absolute indications for tonsillectomy operation:

Hypertrophic tonsils - kissing tonsils

Upper airway obstruction, severe swallowing disorders, sleep disturbances or the presence of enlarged tonsils that can cause cardiopulmonary complications (as in the photo above - kissing tonsil or kissing tonsils). Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications

- Peritonsillar abscess (tonsil abscess) that is unresponsive to medical intervention and drainage procedure documented by the surgeon

Having tonsillitis resulting in febrile convulsions (febrile convulsions)

Tonsil disease that requires a pathological examination (biopsy)

Relative indications for tonsillectomy operation: 
 
- Three or more tonsil infections per year
- Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy
- Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics
- Unilateral tonsil hypertrophy that is presumed to be neoplastic.

These indications may vary when multiple antibiotic allergy.

Tonsillectomy Contraindications

Tonsillectomy in Istanbul - Tonsillectomy Indiciations - Tonsillectomy Contraindications - Tonsillectomy Risks and Complications - Tonsillectomy Techniques - Surgical Procedure - Postoperative Patient Care After Tonsillectomy Operation - Tonsil Removal in Istanbul - Bloodless Tonsillectomy - Thermal Welding Tonsillectomy

Contraindications for tonsillectomy operation include the following:

- Bleeding diathesis (anticoagulated patient or patient with coagulopathy)
- Poor anesthetic risk or uncontrolled medical systemic illness
- Anemia
- Acute tonsillar infection

There Is A Relationship Between The Size Of The Tonsils And The Frequency Of Cardiovascular Diseases!

tonsil enlargement
In patients with tonsil enlargement (tonsil hypertrophy), it has been shown that the symptoms of upper airway stenosis and associated sleep apnea are exacerbated, and the risk of hypertension and cardiovascular diseases in the long term has been increased. In the latest tonsil surgery guide, it is emphasized that attention should be paid especially to the size of the tonsils. In the above picture of the pediatric patient's throat, the vent hole between the tonsils is quite small. In fact, there are studies showing that blood pressure is higher during sleep, especially in children with enlarged tonsils - adenotonsillar hypertrophy (source:  Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy). Tonsil surgery has a protective role for cardiovascular health in patients with airway stenosis (source link:  Obstructive Sleep Apnoea Syndrome). It has long been known that enlargement of the tonsils and adenoids can cause pulmonary hypertension (source:  Enlarged Tonsils and Adenoids).

tonsillar hypertrophy elongated uvula

In the photo above, an edematous area on the tip of the uvula is seen in the morning examination of a child with snoring complaints. In patients with large tonsils, snoring is more especially in the supine position, the uvula in between can be seen as more swollen and edematous in the morning.

Tonsillectomy Risks and Complications

Tonsillectomy in Istanbul - Tonsillectomy Indiciations - Tonsillectomy Contraindications - Tonsillectomy Risks and Complications - Tonsillectomy Techniques - Surgical Procedure - Postoperative Patient Care After Tonsillectomy Operation - Tonsil Removal in Istanbul - Bloodless Tonsillectomy - Thermal Welding Tonsillectomy

  Risks and complications of tonsillectomy operation are as follows :

- Continuation of recurrent sore throat
- Bleeding
- Infection
- Dehydration
- Prolonged pain
- A permanent change in voice
- Nasal regurgitation

These complications have been reported in the medical literature and they're quite rare.

Tonsillectomy Techniques

Tonsillectomy in Istanbul - Tonsillectomy Indiciations - Tonsillectomy Contraindications - Tonsillectomy Risks and Complications - Tonsillectomy Techniques - Surgical Procedure - Postoperative Patient Care After Tonsillectomy Operation - Tonsil Removal in Istanbul - Bloodless Tonsillectomy - Thermal Welding Tonsillectomy

The techniques of Tonsillectomy can be broadly divided into 2 major categories: extracapsular (total tonsillectomy, subcapsular) and intracapsular (partial tonsillectomy). Intracapsular is also known as “subtotal,” and this procedure is referred to as tonsillotomy in some literatures (Source: A Review of Tonsillectomy Techniques and ...).
Tonsillectomy techniques can be summarized as follows:
- Dissection and snare method
- Electrocautery
- Radiofrequency ablation
- Harmonic scalpel
- Thermal Welding
- Carbon dioxide laser
- Microdebrider




Here I am performing tonsillectomy :)

I usually prefer Thermal Welding method because of minimizing the post-operative pain and other complaints.

You can see more detailed information about this procedure at >> Thermal Welding Tonsillectomy (TWT).




Definition of thermal welding tonsillectomy

"Thermal Welding" or "Tissue Welding" is a system in which pure thermal energy is used for tissue cutting or separating. In this technique, heat damage is minimal in neighboring areas outside the cut area. In this system, which has two pedal zones which are pressed by foot, when the first pedal is pressed, the vessels outside the tonsils are closed with heat energy, when the second pedal is pressed, the tonsil capsule is separated from the surrounding tissue without blood loss and the vision of the surgical field is not disturbed. Heat damage to muscle tissue outside the tonsils is minimal. Therefore, postoperative pain and bleeding are reported to be less than other techniques.

It is emphasized in different studies that tonsil surgery technique with Thermal Welding System causes much less postoperative pain than other systems and this method has more advantages than other methods.

In the last 30 years, the relationship between sleep apnea syndrome and tonsil size has started to be understood more clearly and the frequency of tonsillectomy has increased. According to the latest tonsillectomy guide, half tonsillectomy with laser, reduction of tonsils with radiofrequency and complete removal of tonsils by thermal welding method is recommended. Radiofrequency energy is applied to different areas of the tonsils with the probes produced for tonsils in the reduction of tonsils with radiofrequency. In this method, small abscess areas may occur in the tonsils and pain may be excessive. In laser tonsillectomy, the duration of pain may be longer since laser-induced mucosal burns are more difficult than other methods.

The Thermal Welding Method is designed to minimize tissue damage around the tonsils. In postoperative surgical areas of the mouth, heat damage is less than other methods and therefore shortens the recovery time. In patients who underwent tonsillectomy with thermal welding method, ear pain and sore throat are less common. It also minimizes blood loss during surgery and shortens the operation time.

Tonsil surgery has shown positive effects on heart health and sleep quality in people with large tonsils. Thanks to this new, modern system, tonsillectomy can be performed easier and less painful than tonsillectomy performed in previous years.

Tonsillectomy Surgical Procedure

Tonsillectomy in Istanbul - Tonsillectomy Indiciations - Tonsillectomy Contraindications - Tonsillectomy Risks and Complications - Tonsillectomy Techniques - Surgical Procedure - Postoperative Patient Care After Tonsillectomy Operation - Tonsil Removal in Istanbul - Bloodless Tonsillectomy - Thermal Welding Tonsillectomy
Tonsillectomy Surgical Procedure

Tonsil surgery is usually done under general anesthesia. Processing time is between about 20-40 min. Thermal welding method is a method than others bloodless and painless

Tonsillectomy in Istanbul
Tonsillectomy in Istanbul
Injectable local analgesics can be used during surgery. Anterior and posterior plica tonsillaris can be sutured to reduce the risk of bleeding and pain.

During tonsillectomy, in methods of tissue damage in tonsillary fossa is less, it is even less post-operative pain.

I generally prefer thermal welding or tissue welding method to mimimize the extratonsillar tissue damage.

Postoperatively, the anterior and posterior plicas of the tonsils are not routinely sutured. In selected patients, suturing the anterior and posterior folds may reduce the risk of bleeding.

Bloodless, Knifeless, Painless Tonsillectomy Method: Thermal Welding Tonsillectomy

(Perhaps it is more scientific to write "less painful" instead of "painless" as the slogan here!)


Tonsillectomy Operation With Thermal Welding Device
Tonsillectomy Operation With Thermal Welding Device

How is tonsillectomy performed?

Tonsil surgery is one of the most common surgical procedures in the world. The procedure is performed under general anesthesia. The patient's head is tilted back slightly. After the automatic retractor is placed, the tonsil surgery is started. The most recent and most current surgical technique is tonsillectomy with Thermal Welding System. There is no need to use additional knives, scissors and other tools in this system. Tonsil front of the upper part of the process begins. First, the tissue vessels are coagulated by using thermal energy in the mode of stopping the bleeding, and then they are removed together with the tonsil capsule by cutting mode. Bipolar radiofrequency can be stopped at the end of surgery if there is a bleeding area. After the tonsil surgery, the front and back plicas in the tonsil pit can be stitched with fusible stitches and the operation is terminated. Tonsil surgery together with tonsil surgery and ear tube surgery can be done.

In the following four videos, tonsillectomy operations with Thermal Welding Device are seen. After surgery, there is no evidence of burn injury outside the tonsils and tonsillar bed, and blood loss is seen to be negligible during the operation.

Tonsillectomy Operation in Istanbul

Thermal Welding Tonsillectomy Operation Video - 1


Thermal Welding Tonsillectomy Operation Video - 2


Thermal Welding Tonsillectomy Operation Video - 3


Thermal Welding Tonsillectomy Operation Video - 4

Postoperative Patient Care After Tonsillectomy Operation

           
Postoperative Patient Care After Tonsillectomy Operation

The first 4 hours after surgery, oral feeding is not done. First is fed with ice cream or cold milk desserts. After this period, oral feeding with liquid food are planned. It is very important to drink water at frequent intervals.

Oral solid, hard, sharp, spicy, hot and extremely sour foods should be eaten. 5th day post-operative pain becomes maximum. Usually the first 7-9 days after the pain starts to decrease and disappear.

The first 10 days are at risk of bleeding. 3 days after surgery, ear pain hit can be seen at night. Simple pain relievers available the first week. Drinking of  water at night can accelerate healing. Hydration is the most important factor that increases post-operative recovery.

Postoperative Recovery Period


Tonsillectomy Operation in Istanbul
Since it is performed under general anesthesia, oral nutrition is not given for the first 4 hours after surgery. Patients usually experience a painful period after tonsil surgery. The recovery period is in two separate periods. The first period is the period when the pain is more and the second period is the less pain. After the operation, a few practical applications that reduce pain are pouring cold serum into the operation area, painkiller injection, injection of dexamethasone and pain medication through the vascular access, and avoiding cauterization. Generally, I prefer to sew the front and back plica as shown in the photo to accelerate the recovery or stop the bleeding areas. After a few practical applications, there is almost no pain for the first 4 hours, and when the anesthetic effect passes and the first meal time begins, first eating ice cream and then continuing with a soft warm diet reduces pain. 

Tonsillectomy Operation in Istanbul

In the photo above, on the left, there are photographs of the throat examination of a patient who underwent tonsil surgery before and one week after surgery. In the photo taken in the 1st week, the white fibrotic healing tissues seen in the areas where the tonsils were removed can be mistakenly perceived as inflammation by families.

In the photo above,  on the right, the tonsillectomy area is seen in the 2nd postoperative week. The first painful period is 5-7 days after surgery in children and 7-10 after surgery in those older than 12 years. are the time periods up to the day. In this first period, white-gray healing tissues will occur in the areas where the tonsils are located, and pain that hits the ears with swallowing can be seen.

Tonsillectomy Operation in Istanbul

In the photo above, you can see the intraoral view immediately after the surgery on the left and the first month after the tonsil surgery on the right. The patient was also operated on a bloodless, bladderless tonsil by thermal welding method.

Important Points About Postoperative Patient Care


The worst factor for recovery is that the patient is dehydrated after tonsil surgery. It causes the patient's pain, increased bleeding and infection risks, and delayed recovery. Therefore, the key factor in recovery is increasing the patient's oral liquid food intake. Regular intake of hard and non-hot (soft and warm) foods is the most important factor for recovery. It may be beneficial to use painkillers to facilitate oral fluid intake and to reduce the pain by taking foods such as ice cream, cold pudding, cold yogurt from time to time. It may be correct to take pain relievers before going to bed, as night swallowing and fluid intake will decrease. It should be kept in mind that pain cannot be relieved with pain relief tablets, syrups or sprays alone and the necessity of oral liquid food intake should be kept in mind.

Important Points About Postoperative Patient Care

Above, the throat appearance of the patients who underwent tonsil surgery with thermal welding method and whose plicas in front and back of the tonsils were sutured with dissolvable stitches are seen on the 7th postoperative day.

Tonsillectomy Operation in Istanbul


Bleeding between 5-7% can be seen after tonsillectomy operation. There is a risk of bleeding up to the 10th day, especially since the collagen, which is a healing tissue on the 10th day, is the time of replacement. After the 10th day, the risk of bleeding will gradually decrease with the intake of soft warm food.

Only soft, warm, juicy foods should be consumed for the first 10 days. All kinds of hard and hot food can cause bleeding by contacting the surgical field. However, acidic foods in the first 10 days are unfavorable as they may be irritating and uncomfortable.

Heavy exercise and movements that increase blood pressure should be avoided for the first 10 days.

Cold steam machines can be used to humidify the room air and reduce the drying out of the throat area during the first painful period.

Tonsillectomy and postoperative video


In the above video, an endoscopic view of the preoperative and postoperative throat region of the patient who had tonsillectomy is presented. After the tonsil surgery, where the tonsils are removed, white, fibrotic, healing tissues appear.

During tonsillectomy, trauma to the muscle and mucosal structures outside the tonsils varies. The method that can be advocated as the "best tonsillectomy method" can be described as "the method that minimizes the amount of trauma".Tonsil surgery techniques, tissue trauma and heat damage with little "thermal welding method" has many advantages over other methods. As tissue damage decreases, the amount of postoperative pain and healing time will decrease.

Before and After Potos For Thermal Welding Tonsillectomy Operation

Before and After Potos For Thermal Welding Tonsillectomy Operation

Before and After Potos For Thermal Welding Tonsillectomy Operation

In the photos above, the patient who had tonsillectomy and nasal flesh surgery with Thermal Welding method, has a postoperative throat view. It is seen that the front and back plicas are sewn with fusible seams. Since pain medication is injected into the surgical site, there are small bleeding areas attached to the needle entry points.

And my angels after tonsillectomy operation :)

Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul
Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul
Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul
Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul

Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul
Dr.Murat Enöz - ENT Doctor in Istanbul - Tonsillectomy in Istanbul - Tonsillectomy in Turkey - Tonsil Removal in Istanbul

Source links:

  • Effects of tonsillectomy on sleep study parameters ...

  • Mortality and major morbidity after tonsillectomy

  • Tonsillectomy: MedlinePlus Medical Encyclopedia

  • Clinical Practice Guideline: Tonsillectomy in Children

  • Tonsillectomy Definition - Tests and Procedures - Mayo Clinic


  • Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
    Appointment Phone: +90 212 561 00 52
    E-Mail: muratenoz@gmail.com
    Mobile phone: +90 533 6550199
    Fax: +90 212 542 74 47



     
    

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