In followup to our last post, today we are going to talk
about tonsillectomy and adenoidectomy.
As we discussed, the indications for this procedure have changed greatly
over the last 20+ years. Formerly, it
was a procedure done for infections and now it is much more frequently done for
obstructive sleep apnea. Whatever the
indication for surgery, the procedure really is the same.
For children, the day before surgery your doctor will
generally want them to have nothing to eat or drink after midnight. This can be variable from center to center so
be sure to discuss this with your doctor at your appointment. It truly depends on the time of day your
child will be going to surgery. Once at
the surgery site, your child will be checked in and routinely will go to a
preoperative holding area ("PREOP").
There, your child will get a gown, get their vitals taken, meet the
operating room team, see your doctor as well as meet and talk with the
anesthesiologist. This is a great time
for any last minute questions that have come up since your last appointment.
Depending on the child and the medical condition, your child
may receive some relaxing medicine in the preop area. Then, it is off to the operating room. The anesthesia team will put your child to
sleep and then the surgery begins. The
surgery time, from the time the patient leaves your side to the time the doctor
comes to talk to you is about 30-45 minutes.
Afterwards, the anesthesiologists begin the wake-up process and the
children come to the recovery room. Once
safe and awake, you will be called back to be with your child. Some children will be required to stay
overnight in the hospital for observation.
This will be at the discretion of your surgeon. Usually, most children are able to be
discharged the morning after surgery if required to stay.
The first 5-7 days are usually the most difficult in the
recovery. Then the children are starting
to feel a bit better. They should
maintain a soft diet for 2 weeks after surgery.
This means nothing crunchy to eat.
No chips, crackers, cookies, crusty breads, or pizza crust. Popsicles, ice cream, macaroni and cheese,
mashed potatoes, and things like these are good things with which to
start. We also ask that you keep the
child's activity under control for the first 2 weeks after surgery. This can be difficult, which we understand,
particularly during that second week. We
generally recommend a week home from daycare or school and then they may return
with the understanding that they will have a reduced activity for the next
week.
There are many different techniques to remove the tonsils
and the adenoids. You may hear about
cold dissection, coblation, electrocautery, microdebriding, laser, and
others. Just remember that these are all
tools that your doctor can use to accomplish the goal of removing the tissue
that needs to be removed. This will vary
from surgeon to surgeon.
Even though this procedure is one of the most common
procedures done across the United States, there are still risks involved. In general, we go through the mouth to remove
the tonsils and adenoids. This places
the lips, teeth and gums at risk because they are in the path of getting
equipment into and out of the mouth during the procedure. The risk of a severe injury is rare. Things to consider include dislodging of a
loose tooth and a burn to the lips as potential problems.
Bleeding is the risk we tend to worry about the most. The risk of bleeding from the nose or mouth after
removing the tonsils and adenoids is around 1-3%. That risk has been stable in the literature
throughout the years. Fortunately the
chance of severe bleeding is rare, and the chance of needing a blood
transfusion or something worse happening is very uncommon. If there is any bleeding from the nose or
mouth after surgery, be sure to contact your doctor.
Removing the tonsils and adenoids is a painful
procedure. This is likely related to the
fact that the tonsils sit in a bed of muscle, and, in addition to that, we are
creating a large open wound like a big ulcer in the back of the throat. Your doctors will give you an appropriate
pain regimen for after surgery but you have to encourage your kids to take
it. It is also important that the throat
stay well hydrated during this time. A
dry throat after surgery is very painful and can lead to not wanting to drink
and more pain until one ends up back at the hospital with dehydration.
When the tonsils and adenoids are removed, we are increasing
the space in the back of the throat.
Sometimes, it is too much space and the body is not able to compensate
for that. Particularly, the palate can
have a difficult time closing the gap between the throat and the nose. This may result in a change in the voice to a
hypernasal quality. You might think that
your child already has a nasal voice from this tissue, but in general, that is
a hyponasal voice: an obstructed voice from too much tissue in the back of the
throat and nose. If this happens, it
frequently will resolve on its own. If
not, about 1:1,000 children will require speech therapy or potentially even
surgery to correct this.
There are small risks of the adenoids regrowing or scarring
in the back of the nose. These happening
to any significant degree is rare, but may mean an additional surgery or
medication down the line.
For these reasons, we as surgeons try to make sure you as
parents are well informed prior to making a decision to go to surgery. Be sure to ask any questions that you have so
that you are able to make the best decision.
After surgery, be sure to contact your doctor after for a fever over
101.5, pain uncontrolled by medication, bleeding, poor oral intake, decreased
urination, or any other concerns. Please
check out Dr. EJ on Twitter @DrEJ76 and @childrenentdocs and like us on Facebook:www.facebook.com/ChildrensENT.
