In adults, tonsils must be operated on when they are affected by a tumour or recurrent infection or after suffering from one or two pretonsillar abscesses. Also in chronic snoring surgery and sleep apnoea surgery.
It children, besides from recurring tonsillitis, sleep apnoea is also common.
Tonsils are always operated on with general anaesthesia. Depending on the cause that triggers the surgery and the size of the tonsils, different surgical techniques shall be practiced:
On recurring infections or pretonsillar abscesses, total tonsillectomy must be practiced, removing all tissue that may bring the infection back.
Dr Máiz has a lot of experience with total tonsillectomies under microscope and assisted by laser. This technique is very accurate when removing the affected tonsil without damaging the surrounding tissues and with better control of the hemostasis, which translates into less painful post surgery and less bleeding.
Total tonsillectomy will be applied if the presence of a tumour is suspected.
Tonsillectomy shall also be total if it is associated to uvulopalatopharyngoplasty (removal of tissues of the palate in chronic snoring surgery).
In children with tonsils bigger than normal, partial or subtotal tonsillectomy will be practiced.
When the size of the tonsils causes sleep apnoea, laser subtotal tonsillectomy is recommended.
When the size of the tonsils only causes snoring, radiofrequency partial tonsillectomy is recommended.
When there's tonsillar hypertrophy, the patient has generally checked the adenoid vegetations, and if they were also big, adenoidectomy would be practiced also.
Adenoids, also called adenoid vegetations, are lymphoid tissues similar to tonsils located on the ceiling of the pharynx (behind the nose). In children they can be oversized, thus blocking the nasal cavities and making the child breath through the mouth, and even blocking the Eustachian tube, causing secretory otitis media (serous otitis).
Adenoids must be operated on in the following cases:
When they cause chronic serous otitis or recurrent acute otitis.
When the tonsils have to be operated on and the adenoids are big.
When the child, due to a total blocking of nasal breathing, develops dental malposition
Lingual and lip frenulum
In both cases, they must be operated on when they are too short. Too short lingual frenulum causes pronunciation impediments, and too short lip frenulum causes the upper gum to show
What causes snoring?
One snores when the soft tissues of the upper respiratory tract relax and vibrates when one is sleeping. Most of the times snoring is caused by overgrowth of the soft palate and uvula, even though tong, tonsils, adenoids and congested nasal cavities might also contribute. The level of the snoring may worsen with alcohol, tobacco and overweight.
Is snoring bad for my health? Snoring may be a sign of obstructive sleep apnoea, a syndrome that stops the affected from breathing various times in their sleep. The doctor must perform a complete analysis to establish whether you just snore or have a more serious breathing problem. Any of these cases can be treated easily: simple snoring is treated with radiofrequency, and sleep apnoea with various other treatments.
How will the doctor study my snore?
If you are considering the possibility of treating your snore, dismissing sleep apnoea is essential. Your medical record will be thoroughly examined. The best way to evaluate your snoring and breathing patterns is with a test under medical vigilance during the night (nocturnal polysomnography)
How is it treated?
The treatment will depend on the seriousness of the case. Should there be severe obesity, it must be treated, and the patient will have to quite myorelaxant medication (sleep pills, tranquilizers, etc) and alcohol. When there is just snoring without sleep apnoea in which the uvula al soft palate are low, radiofrequency is recommended. Should the palate and tonsil tissues be excessively big, an intervention is recommended, which consists on drying out the excess of soft palate and tonsils in order to obtain as much free space as possible (uvulopalatopharyngoplasty). This procedure can be performed by traditional surgery or laser surgery.
What is radiofrequency?
Radiofrequency is a procedure in which low temperature and low power energy are used to treat a well defined area of the uvula or soft palate. This energy is sent from below the surface of the soft palate (mucosa). The tissue being treated heats enough to create a coagulation area. During the following three to six weeks the treated tissue is eliminated naturally, decreasing the volume and strengthening the area responsible for the snoring. There may appear some inflammation or discomfort during the following days to the procedure that feel like a cold. During the following month the patient should feel that their snoring has improved. Depending on its level, it may be necessary to repeat the process. Since the delicate line of the palate is protected, radiofrequency is not very painful at all and allows a faster recovery.
Am I a candidate to radiofrequency?
If you snore loudly frequently and do not have any other breathing problem, radiofrequency might be the best option.
The energy is sent under the surface of the soft palate.
The treated tissue is heated enought to create a coagulation area.
During the following four to six weeks the treated tissue decreases and strengthens.
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