Part 4 

The Tonsillectomy Procedure.

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Options for tonsillectomy

There are many ways to crack an egg, and the same is true with tonsillectomy. If you are arranging a tonsillectomy for your child, there is no real need to look any further than the standard NHS tonsillectomy, as 3 year olds do well with this. However, once the child gets past the age of 8 or 9, or if the procedure is for an adult, this traditional technique becomes a real nightmare in most people, with severe pain lasting up to or over 3 weeks post op, a high risk of postoperative infection or bleeding, and long term consequences such as swallowing or speech difficulty.

New techniques have been devised to overcome this problem in older children and adults. They basically involves an intracapsular removal of the tonsil. The capsule is the very edge of the tonsil as it sits in the throat, surrounded by muscle and blood vessels. It doesn't contain any tonsil tissue as it is made up of connective tissue alone. It is a very thin layer, and is hard to completely preserve, so the way around this is to leave a tiny rim of tonsil tissue next to the capsule. Preservation of this rim of tonsil and the capsule means that the blood vessels and muscle surrounding the tonsil are not exposed to the saliva and food etc in the mouth and throat. Healing is much quicker, and pain and bleeding risk is vastly reduced. Mr Mike Dilkes’ series of over 1,500 intracapsular general anaesthetic laser tonsillectomies in adults has had just three cases of secondary haemorrhage that needed to go back to the operating theatre - and these were all fine in the end. Pain lasts for around seven days and the majority of patients eat normally throughout, albeit using quite strong painkillers. Laser vapourisation isn't the only way of performing intracapsular removal of the tonsils - Coblation also works well for this.

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Intracapsular laser removal of the tonsils

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We try and perform most of our laser tonsillectomy procedures in clinic using numbing spray only. It's incredibly effective, particularly for tonsil stones and bad breath sufferers. It hardly ever bleeds and the patient goes straight back to work, so it's called a lunchtime procedure. Post op pain is usually very low, and controlled with Paracetamol. Patients are encouraged to eat normally during the 5 day healing process. It's a sequential removal of the tonsils, so in 1/3 of cases more than one procedure may be required. For big tonsils or patients suffering with recurrent tonsillitis several procedures may be necessary before symptoms are eradicated.

In special circumstances we have to go under general anaesthetic in hospital as a daycase. Then we use the high powered computerised pattern generator scanned carbon dioxide laser, delivered via an operating microscope and micro-manipulator. There is usually no blood loss during the procedure, with patients discharged home eating and speaking normally, around 4 hours after the operation is over. Return to work / school can be within 48 hours of being discharged. When patients are reviewed in clinic 4 weeks after the operation, there is virtually no scar tissue, and speaking/swallowing function is entirely unaffected by the procedure. The downside of this procedure is that there is a small rim of tonsil tissue left behind, and this can cause further problems, such that a second procedure is required, usually under local anaesthetic spray. This happens in about 1 in 20 cases.

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You can watch a video of the tonsillectomy procedure here.

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Tonsillectomy - Private or NHS?

The chances of getting an NHS tonsillectomy as an adult are becoming very low, as recent Department of Health announcements have stated.

In the private system you have choice - Surgeon, type of tonsillectomy, Hospital, date. It is extremely unlikely your operation will be cancelled, or delayed, or that there won't be enough staff. You will have your own room and bathroom, satellite TV, waitress service for meals, snacks. You will be personally looked after by your consultant, who will be available if you have any complications / problems, or simply want to ask a question. Your anaesthetist will be fully trained consultant. Prices do vary a little throughout the country. In London with Mike Dilkes, a full intracapsular general anaesthetic laser tonsillectomy in Hospital as a daycase is £3,920 this includes post operative follow up.