Tonsillectomy New Vistas

Introduction:

History of tonsillectomy dates back to within a little 2000 years. It was Celsius who foremost described the procedure in the earliest century A.D. The potentials with a view to complications after this surgical procedure are again very high despite the advancements in technology. There is distil no consensus between the otolaryngologists concerning the safest operating technique which is not attended the agency of any of the classic post effectual complications described after tonsillectomy.

None of the evaluated procedures has clearly shown that speed operative pain could be minimized. The reason for post operative pain following tonsillectomy is fit to disruption with exposure of underlying manhood endings (glossopharyngeal and vagus), and pharyngeal constrictor muscle fibres. Postoperatively exposed to foreign elements the exposed muscle fibres be subjected to spasm causing pain while swallowing. Any newer surgical technique should management this aspect of inflammation involving the pharyngeal constrictor muscles.

Subtotal intracapsular tonsillectomy:

This general is based on minimal tissue harm. The pharyngeal constrictor muscles are not exposed. The unseasoned nerve endings are also not exposed to the environment. The set operative pain after this procedure is self-same minimal and the patient undergoes a weight free convalescence period. In this practice radio frequency probe is used. This technique is also known as "Temperature controlled radiofrequency tonsil diminution". In this technique a RF look into is introduced into the tonsillar fabric and heated up to 40 - 70° C. A plasma province containing highly ionized particles is formed at the verify's surface causing tissue destruction. This verify can thus be used to call into existence small channels in the tonsil by dissipation of the energy released by ionizing radiations. This causes tissue ruin during the following days / weeks of surgery capital on to a gradual reduction in the glutinous substance of tonsillar tissue. Initially there is an increase in the size of tonsil owing to soft tissue oedema. Tonsil shrinkage usually occurs between the first and third weeks. The high sea advantage of this procedure is that from that time the tonsillar bed structures are minimally damaged, these patients are indubitably pain free even on the before anything else post operative day.

Advantages of radiofrequency sift versus conventional diathermy / electrocautery:

Radiofrequency generators occasion at lower frequencies than conventional electrocautery units. The wounding action of R.F. cautery occurs at 70° C. This is much lower than the cutting temperature of bargained for electro cautery units which ranges betwixt 400 - 500 C.

The high current closeness which is released by the electrode causes a brisk increase in the local temperature ranging from 50 - 80° C. This propagate in temperature causes coagulation, protein denaturation and invariable tissue destruction. When the tissue degree of heat reaches the critical level of 100 C boiling occurs at the electrode tissue interface. This boiling causes the tissue coagulum to be firmly fixed to the electrodes disrupting the current grow through the prongs.

Radiofrequency ablation uses frictional heating that is caused when the ions in the combination attempts to follow the changing directions of alternating current.

These devises hold sensors close to their tip what one are capable of monitoring tissue temperatures. When the limited tissue temperature reaches 100 C the sensor automatically shuts away the current to the generator ensuring that the chain temperature does not exceed 100° C.

During RF tonsillectomy the satirical mode should be paused for 10 seconds in opposition to every 10 seconds of tissue keen.

Cold ablation tonsillectomy:

This procedure was first invented by Philip E. Eggers and Hira V. Thapliyal in 1999. This surgical operation is performed by passing an full of fire current through a conductive saline media. The sodium ions in the briny are released. These sodium ions weaken down intracellular bonds at temperatures ranging from 45 - 60° C. The salt-pit solution lowers the surrounding tissue temperature minimizing collateral excess tissue damage. Since this devoid of warmth ablation technique uses bipolar probes, earthing electrodes are not necessary. Saline must be used in enough quantities. If the amount of salt-spring used is too low ablation fails to occur. Pressure should not have ing applied while using the probe tip. Application of excess pressure will object more bleeding.

Inside out tonsillectomy:

This manner of proceeding is otherwise known as intracapsular tonsillectomy. The indispensable advantage of this procedure is reduced mail operative complications like pain bleeding etc. A micro debrider can be used to perform this management. The rotating debrider blade is used to shave off the tonsillar tissue from its sheath. Bleeding points if any should be cauterized using bipolar cautery. The surgeon places the rotating debrider gallant in the middle of the tonsillar mass. This is done to prevent the debrider dashing fellow from straying too close to the verge of the tonsillar tissue. A retractor be able to be used to shield the edges of tonsil from the rotating flat part. Surgeon should take care while acting close to the inferior pole and anterior and posterior edges of tonsillar woven stuff as these areas are highly vascular. The debrider buck should rotate at full speed, otherwise suction increases and debridement ceases.

As the debrider buck penetrates the tonsillar tissue its make-shift changes. The middle will be fortunate and it barely bleeds. As the leaf gets closer to the edge of the tonsillar covering a red streak starts to strike one as being. The red streak indicates the limits of tonsillar examination.

Harmonic scalpel tonsillectomy:

This procedure is performed using one ultrasonic harmonic scalpel. The sound frequency used is about 55.5 KHz. The major advantage of this procedure is reduced phlebotomy and post operative pain. However operating time is doubled whereas compared to the normal cold dissection and snare method.