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Radiofrequency tonsillectomy
Most tonsillectomies today are performed with some sort of radiofrequency device. This device uses a pointed instrument and heat to excise the tonsil tissue. The radiofrequency tonsillectomy is essentially effective and relatively safe. But it poses substantial postoperative disadvantages for most patients.Disadvantages
The main drawbacks of a Bovie tonsillectomy include:- Intense postoperative pain
- Slower recovery and return to normal activity
- Increased risk of dehydration and delayed bleeding
The major disadvantage of the radiofrequency technique is that most patients experience considerable pain after surgery that requires strong pain relievers. Intense pain prolongs the recuperation period and may be so severe that it causes dehydration.
Why are traditional methods of tonsil removal so painful?
The tissue in the throat contains many nerves that are highly sensitive. Traditional tonsillectomies usually remove 100% of the tonsil tissue, which totally exposes the underlying throat muscles. A recent theory asserts that this directly relates to the severe pain, slower recovery and higher rate of complications associated with conventional tonsillectomies.
The exposed throat muscles are vulnerable to bacteria that release endotoxins, which increases the pain and swelling. In addition, the surgeon has to cauterize (burn) the throat muscles directly to stop any bleeding that occurs. This combination of muscle exposure, thermal injury, and bacteria-produced toxins contributes significantly to the severe pain many people experience after a traditional tonsillectomy.
The problem is exacerbated because it takes some time for these sensitive tissues to heal. Throat tissue experiences a lot of movement because we swallow frequently, not only for eating and drinking, but the normal swallowing of saliva, as well.
Slower recovery
Because the pain is so severe after conventional tonsil surgery, many children recuperate more slowly and have to stay home from school longer. Typically it takes seven to ten days for a child to return to normal activity and diet following a traditional tonsillectomy. This means parents have to take time off from work to stay home with their recovering child. Adults who undergo conventional tonsil surgery may take even longer to recover.
A number of changes in technique and technology have occured to eliminate some of the pain associated with radiofrequency total tonsillectomy. Namely, these techniques seek to reduce thermal injury. Coblation® does this by incorporating a saline bath into the device. Other surgeons use the needle-tipped device at a very low power setting. These advancements have helped somewhat as to allow the patient to return to normal activity at five days post-op. This is a drop from the traditional 7 to 10 days recovery times of the past.
Increased risk of dehydration and delayed bleeding
Dehydration and bleeding are the two main complications associated with tonsil surgery. Dehydration can occur when the pain upon swallowing is so severe that it inhibits normal drinking and eating. Some children have to be readmitted to the hospital to receive intravenous fluids due to dehydration, which happens in 3-4% of traditional tonsillectomies.
Delayed postoperative bleeding is a complication that can occur up to one week after a tonsillectomy. This requires 2-4% of patients to be readmitted to the hospital to control the bleeding. Very rarely, delayed postoperative bleeding may result in death.
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How are they removed?Combined tonsillectomy and adenoidectomy (T&A) techniques  Important Safety Information |
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Version 2.1.0 This webpage was first published on September 08, 2005, and was last updated on August 31, 2007.
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