Tonsillectomy and adenoidectomy remain the most common surgical procedures performed by an ENT surgeon. It also remains a controversial procedure as to the benefits and complications. Parents of young children can be bogged down in emotional hysteria and misinformation regarding not only the function of this tissue but also the complications of surgery.
Since the first tonsillectomy was performed by Celsius in 30 BC, multiple surgical techniques have been described, most notably in the 21st century. From the standard procedure of blunt dissecting and tying off of possible bleeders to laser tonsillectomy, all have come with their own set of different complications. The main two, however, remain that of post-operative pain and bleeding. The onset of Coblation surgery has minimized these two main complications.
Let us start by understanding the basic concepts. What is adenoid and tonsillar tissue and what is their function? Although these are seemingly simple questions, the answer or lack there-of is probably the reason for the confusion and emotional debate.
Tonsils and adenoids are lymphoid (glandular) tissue clumped together in the back of the throat and nose respectively. What is often forgotten however, is that they form part of a ring of lymphoid (glandular) tissue in the nose and throat area called the Waldeyer ring, named after the German surgeon first describing this ring in the early 20th century
The perception by many patients are that tonsils and adenoids act as a “filter” for bacterial and viral organisms and by removing them, the body will be prone to more infections which will manifest at other sites in the body. The function of the adenoids and tonsils are to stimulate the immune system for viruses and bacteria entering the area. Their function is to produce specific antibodies to infections that pass through the nose and mouth. This function can and will be performed by the remaining tissue in the Waldyer ring after an adeno-tonsillectomy. Numerous studies have shown that the immune system will not be compromised by an adeno-tonsillectomy. As to any further knowledge of any other function these remain uncertain.
Lymphoid tissue contains crypts (“pits”) on their surfaces and it is these crypts that act as a home for the common bacteria and viruses that can cause your child to become ill in the upper airway. In a way, the adenoidal and tonsil tissue become the problem as the crypts harbour infective organisms and thus become ineffective in stimulating the immune system and cause chronic recurrent infections. The indications for surgery are recurrent upper respiratory tract infections due to “sick” tonsils or obstruction of the nose and throat due to enlarged glandular tissue. No child is supposed to snore and if they do, it is a sign of obstruction of the airway.
Coblation tonsillectomy utilizes a sodium rich solution which fills the space between the tonsil tissue and the tonsil bed combined with an electric current that dissociates (breaks-up) the sodium ions causing tissue destruction. Bleeding points are minimized and identified immediately with Coblation surgery due to the excellent and almost bloodless surgical field. The incidence of post-operative bleeding has thus diminished significantly.
Local tissue damage is reduced because much less heat (40º C) is generated as compared to laser surgery or bi-polar tonsillectomy where temperatures to local tissue can reach 600ºC. This allows for much less pain and the possible co-morbidity of dehydration due to a child that refuses to eat or drink.
Surgery on any patient should never be taken lightly. The benefits of an adeno-tonsillectomy in cases where your ENT or Pediatrician have recommended it, have with the advent of Coblation becomes a much less frightening experience.