- palatine tonsillectomy
- lingual tonsillectomy
Tonsillectomy is the removal of the palatine or lingual tonsils at the back of the throat. The tonsils, along with the adenoids, are part of the system that captures germs entering the body and triggers an immune response to an infection.
Who is a candidate for the procedure?
The palatine tonsils
are easily seen on either side of the throat at the level of the soft palate. Removal of the palatine tonsils is an appropriate treatment in the following situations:
- if there have been 3 to 5 bacterial infections of the tonsils within 3 to 5 years
- if there have been more than 6 episodes of tonsillitis in a year
- if chronic tonsillitis, or infection of the tonsils, does not respond to antibiotics
The lingual tonsils
are areas of tonsil tissue at the back of the tongue. They may be removed for one of several reasons, including:
- recurrent or chronic tonsillitis
- enlargement of the tonsils that causes sleep apnea, a breathing disorder that occurs during sleep
- enlargement of the tonsils that causes difficulty swallowing, especially in children
- diagnosed or suspected cancer
How is the procedure performed?
A tonsillectomy to remove the palatine tonsils is usually done under general anesthesia, which means that the person is put to sleep for the procedure, feels no pain, and has no awareness of the operation. A device holds the mouth open, and a clamp is applied to the tonsil. An incision is then made in the lining over the tonsil.
This incision can be made with scissors, knife, laser, or electrocautery, in which a pencil-like device connected to an electric current gently burns through tissue, avoiding the use of a knife. The incision exposes a loose tissue layer between the tonsil and the muscles of the palate. The tonsil is then "shelled" out.
General anesthesia is also used when the lingual tonsils are removed. The mouth is held open by an instrument called a laryngoscope, a lighted tube through which the lingual tonsils can be seen and removed. The lingual tonsils are at the back of the tongue and are rather firmly attached to the muscles of the tongue. The tonsils are separated from the muscle using either laser or electrocautery.
Because the tonsils have such a good blood supply, there is often quite a bit of bleeding from numerous tiny vessels. This bleeding can usually be stopped by touching the tip of the electrocautery device to the vessel. Commonly, the adenoid is also infected and is removed as well.
Recently, the Food and Drug Administration (FDA), approved a radiofrequency procedure to shrink tonsils in adults, rather than removing them. This procedure is done in a healthcare professional's office using only local anesthesia, which numbs the area around the tonsils. The person sits and opens his or her mouth while the healthcare professional applies bursts of radiofrequency heat with a needle-like device or wand.