Removal of the glands: indications, methods of removal
Jun 02, 2018
The removal of tonsils( tonsillectomy) is an operation that was carried out back in ancient Rome.Confirmation of the mention of the progress of the operation in the works of Cornelius Celsus, who lived at the beginning of our era.And although hundreds of years have passed since that time, the operation has not lost its relevance and is being carried out now everywhere.Table of contents: Indications for tonsil removal Contraindications Methods for removing glands
Indications for the removal of tonsils
Tonsils are a small organ that is a cluster of lymphoid tissue between palatine arcs.In people, tonsils are often called glands.The purpose of this body is to protect the organism from microorganisms penetrating from the outside with air and food.Tonsils have a porous structure and are laced with depressions - lacunae.
However, under certain circumstances, the tonsils are not able to fully perform their protective function and even become a hotbed of chronic infection.In this case, the doctor may consider the option of removing tonsils from the patient.
- Repeated severe sore throats;
- Ineffectiveness of conservative therapy of chronic tonsillitis;
- Diseases that have arisen against the background of angina( rheumatic carditis, glomerulonephritis, polyarthritis, etc.);
- Paratonsillar abscess and phlegmon, formed against a background of chronic tonsillitis;
- Tonsilogenetic chroniosepsis;
- Increased palatine tonsils, which makes it difficult to swallow;
- The syndrome of nocturnal apnea, caused by an increase in palatine tonsils and adenoids.
Tonsillectomy is usually performed on a schedule, during the remission of tonsillitis.But with such dangerous conditions as zaglugochnye abscess and phlegmon, surgical intervention is carried out urgently under the cover of antibacterial drugs.
Tonsillectomy, like any other operation, has a number of contraindications.Therefore, in the presence of certain pathological conditions, the doctor decides on the appropriateness of tonsillectomy. Contraindications to conduction of tonsillectomy are:
- Blood diseases( leukemia, blood clotting disorder);
- Abnormalities of the pharyngeal vessels( aneurysms, angiodysplasia);
- Severe mental illness;
- Tuberculosis in active form;
- Severe form of diabetes mellitus;
- Severe diseases of the heart, liver, kidneys, lungs in the stage of decompensation.
There are also so-called relative contraindications, when surgery can be performed by a surgeon only if certain conditions are met.Such contraindications include acute infectious diseases, acute inflammatory diseases of internal organs, dental caries, menstruation, hypertension.
Age by and large is not a contraindication.Due to modern developments, tonsillectomy can be performed both for children aged from three years old and for older people.
Methods for the removal of tonsils
Regardless of the method by which tonsillectomy is performed, the patient needs to undergo specific studies.This definition of blood type and Rh factor, a clinical blood test, a blood test for clotting, a general urine test.If necessary, the surgeon can also refer the patient to a consultation with a narrow specialist in order to understand how the operation will affect the presence of a somatic disease.
A few decades ago, the only method of removing tonsils was surgical.Now in the arsenal of the otolaryngologist a lot of other modern methods.
Thus, tonsillectomy is performed as follows:
- Surgical excision;
- Ultrasonic removal;
- Carbon laser removal;
- Radiofrequency ablation;
- Removal by infrared laser;
- Removal by microdeveloper.
Tonsillectomy is performed under local anesthesia, less often under intubation anesthesia.On the edge of the anterior palatal arch the doctor applies an arcuate incision, separates the upper pole of the amygdala and grasps with forceps.Then the instrument is extracted with the amygdala to the lower pole.The separated amygdala is removed by a surgical loop.On the bleeding vessels impose clamps, and then ligatures.
After the operation, the patient is laid in bed on his side.In this case, the pillow should be low so that a person does not choke on slime or blood from a wound.Drinking is allowed after six to eight hours, but you can eat only after a day.At the same time in the diet should be food is extremely soft consistency, not hot.Strict bed rest should be observed for three days.
The disadvantage of this method of tonsillectomy is a large tissue trauma, as well as a significant risk of postoperative complications. These complications include:
- of the phlegmon of the neck;
- Subcutaneous emphysema;
- Throat hematoma;
- Glossitis, stomatitis, acute otitis media;
- Pair of cranial nerves.
But the main advantage is the possibility of removing the entire amygdala in one operation, unlike other methods, which may require repetition of manipulation.
This method of tonsillectomy is based on the use of an electric current of high frequency.Electrocoagulation has a destructive effect on the tissue of the tonsils, and also does not allow bleeding during surgery, as the blood coagulates.But still this method has an undeniable flaw.The fact is that the high temperature affects not only the tissue of the tonsils, but also the surrounding healthy tissue, which can cause burns.After the operation, painful and prolonged healing of damaged soft tissues is noted.
A similar method of removal is possible due to the use of an ultrasonic scalpel.The effect is due to high frequency oscillations of the scalpel, due to which the tissue is cut.Also, under the influence of ultrasound, blood coagulation takes place, because of which the operation is not accompanied by blood loss.The temperature of the surrounding tissues at the procedure reaches 80 degrees, which is much less than with electrocoagulation.Thus, it can be concluded that ultrasound affects the surrounding healthy tissues more sparingly.
The essence of this method is the use of radio wave energy, which is converted into thermal energy.The "Surgitron" apparatus possesses similar properties.Manipulation is performed under local anesthesia.During the procedure, a probe is inserted into the tissue of the amygdala, through which the radio wave radiation is fed.As a result, the tissue of the tonsils is scarred for several weeks and decreases in size.That is, the amygdala is not completely removed, but only decreases.Radiofrequency ablation is preferred if enlarged tonsils prevent a person from swallowing or are the cause of nocturnal sleep apnea.
The method of radiofrequency ablation has several advantages.This is the ease of the procedure, and minimal discomfort after surgery.The patient does not need to stay several days in the hospital after the operation.The method of radiofrequency ablation is referred to outpatient methods, which means that the patient can leave the room after the procedure and do his own business.
Infrared laser removal
The infrared laser has a destructive and caking effect on soft tissues.The peculiarity of this method is that the temperature of surrounding healthy tissues rises only a couple of degrees, so the effect of the laser on them is minimal.The advantages of the method are absence of bleeding, edema, and minimal pain in the throat after the procedure.
Carbon laser removal
Carbon laser leads to evaporation of the amygdala tissue.This method allows not only to reduce tonsil volumes, but also to destroy all available pockets in which pathogenic microorganisms are chronically accumulated.
The removal of tonsils by a carbon laser is performed on an outpatient basis under local anesthesia and takes no more than twenty minutes.Bleeding occurs extremely rarely.Patients report that pain after surgery is minimal.
Microdeveloper is a tool with a blade at the end that rotates at high speed.Its use allows for gentle, selective excision of the tonsil tissue.With this method, incomplete tonsils are removed, since the capsule is retained.But partial tonsillectomy is not used in case of chronic inflammation of the tonsils.The postoperative period is easily tolerated, the pain syndrome is minimal.
The question of the need to remove tonsils is solved individually.Tonsillectomy should be resorted to in the presence of specific indications, as well as ineffectiveness of the tried conservative treatment.
Grigorova Valeria, medical reviewer