Tonsillectomy Surgery Melbourne
Tonsillectomy surgery involves removing the tonsils from the mouth. The tonsils are collections of lymphoid tissue found at either side of the back of the throat. The tonsils can become inflamed and infected - causing tonsillitis. Sometimes, even without infection, the tonsils can be enlarged.
Tonsillectomy surgery is usually performed for recurrent tonsil infections or because the tonsils are too large and are causing breathing difficulties, particularly when sleeping. Tonsillectomy surgery is performed under a general anaesthetic and the tonsils are dissected out of the tonsil bed via various techniques.
When is Tonsillectomy surgery recommended?
Tonsillectomy surgery is usually recommended where there is a history of recurrent tonsil infections. Patients who have recurrent infections surrounding the tonsils (termed a peri-tonsillar abscess) or ‘quinsy’ can also benefit from tonsillectomy surgery.
The other common indication for tonsil surgery is where the tonsils are causing obstruction - this can lead to obstructive sleep apnoea or sleep-disordered breathing. Much rarer indications include biopsy of tonsil to exclude cancer or for access to other structures in the neck.
Preparation for tonsillectomy surgery
Your surgeon should review all regular medications. Medication that impairs bleeding, such as aspirin, should be stopped for 10 days prior to the surgery. Some herbal preparations and supplements can also promote bleeding (such as fish oil) and should also be stopped before the surgery.
Fasting times for the tonsillectomy surgery will be provided. At least 6 hours of fasting is needed for solids and most liquids. However, there is an emphasis to minimise the fasting times. Usually, clear fluids (e.g clear apple juice and water) can be had up until 2 hours before the surgery.
What is tonsillectomy surgery?
The surgery to remove the tonsils is performed under a general anaesthetic. A device is used to open the mouth and access the tonsils. This mouth, palate and tonsils are examined. There are different techniques to remove the tonsils - dissection and ties, cautery or coblation. Coblation tonsillectomy surgery is a newer technique that uses a plasma field to dissect the tissue with less heat damage. After the tonsillectomy, the tonsil bed is inspected and bleeding is stopped with cautery or surgical ties. If an adenoidectomy is also to be performed - the space behind the soft palate (post-nasal space or nasopharynx) is examined and the adenoids are removed. Bleeding is similarly controlled.
What happens after the surgery?
After the tonsillectomy surgery - the patient is woken up in theatre recovery. For a paediatric patient - the parent is called in as soon as the patient is rousing. An intravenous cannula (or IV) is kept in while in hospital. This allows for fluids and medications to be administered intravenously. This can be important if there is nausea, pain or bleeding.
As soon as the patient is awake - sips of water, ice chips or an icy pole can be taken. Diet is then increased as tolerated. Hot and spicy foods are avoided. There are no other food restrictions.
The patient is transferred to the ward once fully awake. Usually, after tonsillectomy surgery, an overnight stay is arranged. This ensures that pain is controlled and oral intake has been established. For some children, the oxygen levels are monitored overnight.
What is the post-operative care following tonsillectomy surgery?
Patients are discharged home the following day after tonsillectomy surgery. It is important to keep up good oral fluid intake. Fluids are more important than solids in the early stages of recovery. A soft, cold diet of solid foods may be better tolerated initially. There is no restriction on food intact - ensuring sufficient food and fluid intake will help with the recovery.
Regular pain relief should be taken for the first week, as directed. There will be several medications prescribed. Prednisolone (or Redipred for children) has been found to be effective in reducing pain and stimulating appetite during the first week after surgery. It will usually be prescribed. In adult patients or older children, stronger opioid pain medication may also be prescribed in addition to regular paracetamol.
What to expect after tonsillectomy surgery:
Pain after tonsillectomy surgery is to be expected but is variable. The worst day is usually about day five after the operation. There can be pain in the mouth and ‘referred’ pain in the ear after tonsil surgery. This ear pain occurs because of a shared nerve supply between the tonsil and ear.
A white eschar (or slough) covers the area where the tonsils used to be and is normal. It is not pus and does not mean that there is an infection. Persistent high fevers may indicate an infection and requires medical review.
Post-operative bleeding is a risk with all tonsillectomy surgery. There are surgical techniques used to decrease this risk. However, the risk of a ‘post-tonsillectomy’ bleed remains for about two weeks after the surgery. Patients should, therefore, stay within one hour of a major designated hospital for the two weeks after surgery. Active bleeding from the ‘tonsil bed’ requires urgent medical review.
Generally, medications that promote bleeding, such as aspirin or anticoagulants should be avoided after the surgery, for two weeks. Where such medications are normally taken regularly, a plan should be made with the surgeon.
This advice is only general in nature and may not apply to every patient. Please contact Dr. Dan Gordon’s rooms for further information.