Tonsillectomy

Tonsillectomy Specialist Thomas Havas

Does your child need Tonsillectomy?

If you are looking for a formal fellowship trained paediatric otolaryngologist, talk to us!

Professor Havas has completed the highest number of paediatric operations in Australia. Please call us or use the "Book an Appointment" form to arrange an appointment to see him.

Tonsillectomy in Children

Before Tonsillectomy

Tonsils are aggregates of lymphoid tissue in the oropharynx, at the back of the mouth. The tonsils have a capsule on their deep side and are lined by epithelium on the side facing the back of the tongue. They have little dead end crevices called crypts in them. These crypts can accumulate debris; often white dots appearing in the tonsils are not pus but are small tonsil stones or tonsillar debris.

Tonsillectomy is still the most common operation performed in children. The major indication nowadays is not for infection but for airway obstruction. If the tonsils grow large, they can block not only the back of the mouth, but also the oropharynx leading to obstructive sleep apnoea in children.

The human tonsils are immunologically most active between the ages of four years and ten years. It is estimated that approximately ten percent of adults and school aged children experience tonsillar infections annually. The vast majority of these infective episodes are managed medically.

The most common causes of of tonsillar inflammation include:

Tonsillectomy in Children
  • Adeno Virus
  • Influenza Virus
  • Para Influenza Virus
  • Rhino Virus
  • Respiratory Cyntithial Virus

Tonsillectomy remains the most commonly performed operation in the world, and a variety of techniques have been tried to reduce the pain associated with the procedure.

It is a very safe procedure, with significant potential complications occurring in less than one percent of cases.




Newer Tonsillectomy Techniques

Coblation Tonsillectomy

Involves the use of a wand delivering Radiofrequency bi-polar current with an irrigating saline solution at a temperature of only sixty to seventy degrees Celsius. Whether this technique results in reduced postoperative pain is unclear. The operating temperature is much less than that in laser or conventional diathermy surgery and much less physical force is used in separating the tonsil from its bed than in conventional dissection. There is a theoretical basis as to why there should be a reduction in secondary haemorrhage compared to dissection plus bi-polar haemostasis insomuch as there is no physical disruption of the muscle layers and there is less chance of encountering large blood vessels using this technique.

Harmonic Scalpel Tonsillectomy

The Harmonic Scalpel consists of a generator device driving a re-usable hand piece. This is connected to a blade which acts as both a cutting and coagulating device. The generator produces a high frequency alternating current which is passed to the hand piece. The device is controlled by a foot pedal attached to a generator.

The blade simultaneously cuts and coagulates. Theoretically the Harmonic Scalpel has the following advantages -

  • Reduced postoperative discomfort.
  • Early return to activity.
  • Less discomfort from eating.

Unfortunately to date these theoretical advantages have not been shown to be significant. Unlike the use of Coblation the hand piece is re-usable.

Powered Intracapsular Tonsillectomy

Unlike conventional tonsillectomy this technique involves the use of a powered micro debrider for removing tonsillar tissue within the capsule of the tonsil. Theoretical advantage again is reduced peri-operative pain because the plane between the capsule of the tonsil and the superior constrictor muscle is not violated. A micro debrider can also be used to perform/supplement adenoidectomy. The problem with this technique seems to be haemostasis.

The micro debrider provides a quick and efficient way of removing intracapsular lymphoid tissue but control of the bleeding usually involves bi-polar diathermy forceps therefore the theoretical advantage in peri operative pain achieved by using the micro debrider alone is negated by the almost invariable use of bi-polar diathermy forceps. The blade is disposable (currently the cost is around $300.00).

Bi-Polar Radio Frequency Technology: Reduce the Volume of Hydroplastic Palatine Tonsiles

RFITT Bi-Polar Radio Frequency Technology is a method for the local destruction of pathological or excessive tissue. The tissue is heated up to a temperature of between six and one hundred degrees Celsius and coagulated whilst avoiding unintended side effects like massive vaporisation or carbonisation.

RFITT is a surgical intervention used mainly for tonsillar hypertrophy associated with obstructive sleep apnoea in children. It is not a recommended procedure for recurrent infective tonsillitis and/or complications of tonsillitis. The radio frequency energy is applied to the tonsil via several Stab Incisions into the body of the tonsil – usually four to five on each side. The application of energy at each site takes only a few seconds so the total procedure time is in the order of ten minutes. Bleeding is uncommon but if it does occur it is difficult to control because it occurs from within the bed of the remaining lymphoid tissue. Occasionally conventional extracapsular tonsillectomy has to be performed to control bleeding.

Cold Steel Dissection Tonsillectomy

This is the traditional technique for tonsillectomy that has been practiced for over fifty years. The key to successful tonsillectomy with minimal bleeding is early identification of the plane between the capsule of the tonsil and the superior constrictor muscle of the pharynx. The earliest modification of traditional cold steel dissection tonsillectomy was the introduction of diathermy coagulation for control of haemostasis. Small bleeding points and occasionally paratonsillar veins are diathermied without the use of clips and ligatures.


Tonsillectomy at Havas ENT Clinics

The complication rates for tonsillectomy are very similar for the techniques described and appear to be more surgeon dependent than technique dependent.

Although new techniques such as coblation and the Harmonic Scalpel offer some hope in reducing peri-operative morbidity essentially from pain their efficacy is as yet unproven. The increased costs of disposable and/or equipment has to be factored against any potential benefits that will be derived.

The tonsillectomy operation is done under general anaesthesia. It takes one hour of operating time. This involves a one night stay in hospital.

Professor Havas has performed over 10,000 tonsillectomies and has introduced several of the newer techniques including micro dissection of the tonsils. If you need more information about tonsillectomy, please talk to Prof. Havas at Havas ENT Clinics. Our clinic number is (02) 9387 7360.