Paediatric tonsil surgery (Tonsillectomy)
Chronically inflamed tonsils are removed during tonsillectomy. The indication for paediatric tonsil surgery is not universal and may vary from specialist to specialist. While in the past, tonsils were removed in many more cases, nowadays surgical removal is performed in specific cases.
In our hospital, we perform paediatric tonsillectomy over the age of 3.
What is the role of the tonsil?
The tonsil is a paired organ of lymphoid tissue located on either side of the throat. It is part of the ring of lymphoid tissue (Waldeyer’s ring) in the mouth, pharynx (including the lingual tonsil, and the lymphoid tissues in the mucous membranes of the pharynx, mouth, and palate), which is an important factor in the local defence against infections, the body’s first immunological screening station, especially in infancy and childhood.
Tonsils contain important protective cells in childhood and produce antibodies, which decrease with age, so their role is no longer essential above a given age.
From the surface of the tonsil to the inside of the tonsil, there are ducts, in which, under normal conditions, detached epithelial cells, food debris and bacteria can be found.
Due to its location, the enlargement of the tonsils in young children can be dangerous, it can hinder breathing, which can cause serious problems, especially at night and during sleep.
In which cases is it recommended to have tonsillectomy performed?
Tonsil surgery is recommended if tonsillitis occurs frequently, at least three times in a year, and relieving symptoms in a conservative way with medication is not a long-term solution. However, if the inflammation is accompanied by complications, removal is always necessary.
Acute purulent (follicular) tonsillitis is most often associated with fever in childhood, and rarely, in infancy and young children, can cause febrile seizures. As a complication of acute inflammation, an abscess can form around the tonsils, which can even be life-threatening, especially if it sinks into the chest cavity. In the case of an abscess around the tonsil, surgery is necessary in all cases, which can be performed simultaneously with the opening of the abscess, on the day after opening, or at a later time.
Chronic tonsillitis is a purulent nodule for the body that can cause diseases of distant organs at any time. Focal, chronically inflamed tonsils are rather useless to the body and are often no longer involved in controlling infections.
Occasionally, a larger-than-average size may requires removal if it causes difficulty breathing or swallowing, or if it may be associated with snoring or sleep apnoea.
What are the risks of not having the surgery performed?
The risks of quitting surgery can always be determined with an accurate knowledge of the case, but in general it can be said that the failure to have absolutely justified surgery can have serious consequences. In children, febrile seizures due to inflammation of the tonsils can cause nervous system damage, rheumatic fever can cause myocardial and renal inflammation, abscesses and sepsis. Failure to remove the inflamed tonsils can result in an infection that can endanger other organs at any time.
Frequent tonsillitis puts a strain on the child’s body and requires frequent use of antibiotics, which causes stomach and intestinal symptoms, further straining the small body.
How is the surgery performed?
Paediatric tonsillectomy is always performed under general anaesthesia. Removal of the tonsil can be done in a conventional manner, excised with common surgical instruments, as well as with a coblation procedure.
During conventional excision, the otolaryngologist removes the inflamed tissue using scissors, raspa, and an electrocautery. The advantage of the procedure is that there is no need for sutures due to minimal tissue damage, therefore healing is faster. In our experience, after surgery, the patient feels less pain than with laser-assisted or radiofrequency methods.
One of the biggest advantages of the coblation or cold plasma cutting procedure, in addition to the faster wound healing, is also the much milder wound pain after the operation. The essence of the method is to create a focused plasma with the electrically excited electrolyte (NaCl), which breaks down the tissue molecular bonds at low temperatures, the cutting is practically done by evaporating the tissues. As a result, a uniform, fine anatomical surface is formed at the site of the incision, where the wound does not require suturing either, because the plasma incision occludes the small blood vessels at the same time, therefore no bleeding occurs. This significantly shortens the post-operative healing time and results in less pain and discomfort after surgery as no sutures are required either.
Tonsillectomy is performed orally, the mouth is held open by a metal mouth spreader that rests partly on the front teeth and partly on the tongue. Tonsil surgery is performed under intubation anaesthesia. This means that during the operation the child is asleep, a tube is inserted into their trachea through which he is breathed. This protects the lower respiratory tract from getting blood from the surgical wound.
The otolaryngologist excises the tonsil with its capsule from the muscle bed with surgical instruments or coblator according to the chosen procedure.
Adenoidectomy can also be performed at the same time as tonsillectomy.
How to prepare the child for surgery?
For the child, the hospital is a completely new environment, so there is a lot of excitement during the first consultation. For this reason, it is important to prepare the child for what awaits them here.
Considering their age, we tell the child that they must go to get rid of the complaints and tell them in detail what and how it will happen, who they will meet in the few days they have to spend in the hospital. It is important to make the child aware that this is all done for their healing.
Since parents’ calmness and cheeriness can be the biggest help in this, our specialists and case managers provide the most detailed information possible about the procedure prior to surgery, and answer any questions that may arise during the consultations. During the recovery period, our hospital staff will also be happy to help make these few days even more comfortable for both the child and the parents.
We believe that parental presence is the greatest healing force for small patients and at the same time the most reassuring for parents, therefore we provide one parent with the opportunity to stay with the child in the hospital.
What are the risks of tonsillectomy?
As with all surgeries, there are general risks and dangers to paediatric tonsil surgery, about which the surgeon provides detailed information prior to surgery.
After surgery, mild or more severe nosebleeds, bloody sputum, bloody vomit, cough stimuli, cough, and severe restlessness may occur in the patient on the day of surgery. The child may be weak, drowsy and dizzy due to the varying amount of blood loss, surgical stress and medications used, and fever, headache and nausea may occur.
What to do after tonsillectomy?
Bed rest is required on the day of tonsillectomy. Following surgery, the little patient must spend one night in our hospital under observation. During the recovery period spent in our hospital, we provide one parent with the opportunity for continuous stay so that the days spent in the hospital can be spent in complete peace for both the child and the parent.
On the day of surgery, only fluid intake is recommended, then in the following days a dietary, mushy meals with abundant (1-1.5 litters) fluid intake is recommended. Avoid lumpy, hard, spicy, salty foods, carbonated drinks because they can damage and irritate the freshly operated area. During eating, swallowing pain may occur in the ear, which can be alleviated by age-appropriate analgesics.
Tooth brushing should be avoided for 8-10 days after surgery, only a thorough rinsing is recommended.
Make the child understand not to force their vocal cords (do not speak loudly, do not shout while playing) to avoid pain and complications, and try to calm them in all cases not to cry.
Bleeding may occur within 24 hours after surgery and when plaque at the wound site becomes detached (days 5-7 after surgery). The latter can also be accompanied by pain, which is completely normal. If significant bleeding occurs, report it immediately to our hospital or the given on-call otolaryngology to relieve the bleeding as soon as possible.
If there are any other complaints in the days after the operation, feel free to contact our colleagues.
How long does full recovery take?
Wound healing after tonsillectomy is 8 to 10 days after leaving the hospital. During this period, the child needs parental supervision. After leaving the hospital, the child should be kept inside for 1-2 days, but it is not necessary to order a bed rest. The child can also be outdoors from day 3 after surgery.
If the child has no complaints, they go to school, kindergarten or nursery after about a week and a half, but it is recommended that they be exempted from physical education for another two weeks.
We accommodate our clients in a modern, pleasant, air-conditioned single room. Each room has a private bathroom, fridge and TV, as well as free WIFI access. We also provide our clients with individual nurse supervision, who will help your continuous recovery during your stay.