Enlarged tonsils can interfere with breathing and swallowing, and in smaller children they can negatively affect speech development
Tonsils, tonsils or tonsils are clusters of lymphatic tissue located at the entrance to the respiratory and digestive systems.
We can divide them into 3 groups that are made up: pharyngeal tonsils, two tubal tonsils, two palatal tonsils and a lingual (lingual) tonsil. Together, these clusters of lymphatic tissue form a single whole – Waldeyer’s ring.
Surgery of all three tonsils in children is one of the most common surgical procedures in the pediatric group. It refers to the extraction of paired palatine tonsils and the third tonsil (pharyngeal tonsil) known as adenoid vegetation.
Due to their strategic anatomical position, tonsils play a role in protecting the body from microbes.
They are located at the beginning of the respiratory and digestive tracts and are the first line of defense against viruses and bacteria. That is why they are prone to frequent inflammation and can cause a number of difficulties that are successfully solved by tonsil surgery.
Children may experience frequent sore throats, purulent tonsillitis, sinusitis, enlarged tonsils with difficulty swallowing. In addition, complications may occur as a result of long-term tonsillitis; peritonsillar abscess, parapharyngeal abscess, inflammation of the heart, kidneys, joints.
Enlarged tonsils can interfere with breathing and swallowing, and in smaller children they can negatively affect speech development. Due to the enlargement of the third tonsil, obstruction of the Eustachian tube can occur, resulting in the appearance of hearing loss.
Due to these conditions, it is often necessary to remove the tonsils to prevent the development of additional complications. If, in addition to a large number of inflammations of the palatine tonsils, there is also an enlargement of the third tonsil, it is recommended to perform tonsiladenoidectomy, i.e. removal of all three tonsils by surgery.
The removal of all three tonsils is performed in children mainly From the age of 3 onwards .
Today, there are clear guidelines from the Ministry of Health created as a result of research on a large number of operated patients over several years. Absolute and relative indications for tonsillectomy are provided by ISKRA – Interdisciplinary Section for the Control of Antibiotic Resistance.
Tonsils, as accumulations of lymphatic tissue, play a significant role in the body’s immune response to bacteria and viruses that enter the body through the respiratory and digestive tracts.
Tonsillectomy is necessary when, due to permanent exposure to harmful microbes from the environment, the tonsils cannot perform their usual protective function, but are often inflamed and enlarged.
The size of the tonsils depends on age and heredity. Through the first 5 or 6 years of life, the palatine tonsils increase in size and reach their maximum size. After puberty, they shrink so that in adult life only the remains of tissue in the palatal arches remain.
Unlike palatine tonsils, the third tonsil or adenoid vegetation is most developed in childhood, and then gradually decreases.
By puberty, the third tonsil completely disappears. If there are repeated viral or bacterial inflammations, the third tonsil may retain its size or even grow and need to be removed.
Given the anatomical position of the tonsils and their physiological function, frequent inflammatory processes cause swelling of the lymphatic tissue, which has significant consequences for the respiratory, auditory and digestive systems.
Enlargement of the palatine tonsils leads to dysphagia, i.e. difficulty swallowing. It also causes a sore throat, difficulty breathing in the form of mouth breathing, snoring, interruption of breathing during sleep, and retention of food residue and bad breath.
Enlargement of the third tonsil can result in hearing loss in childhood. Namely, due to enlarged adenoid vegetation, the development of otitis media and obstruction of the Eustachian tube is possible. Due to sound conduction disorders in the ear, hearing is weakened.
In the case of the aforementioned problems with breathing, swallowing and hearing in children, possible problems with the tonsils should be suspected.
In order to determine the need for tonsillectomy, it is first necessary to perform a specialist examination by an otorhinolaryngologist. During an ENT examination , it is possible to determine inflammation or enlargement of the palatine tonsils.
Adenoid vegetation or the third tonsil, due to its special anatomical location, is not visible during clinical examination.
To confirm an enlarged third tonsil, it is necessary to perform an endoscopic examination of the nose and throat, the so-called fiberendoscopy. With a special flexible endoscope, it is possible to examine in detail the entire nasal cavity, the nasal part of the pharynx, the base of the tongue, and the larynx.
In the operation of all three tonsils, the procedures of removing the palatine tonsils are combined with the removal of adenoid vegetation, i.e. the third tonsil.
It is not uncommon for children who suffer from recurrent tonsillitis to enlarge the third tonsil in addition to enlargement of the palatine tonsils, in which case surgery of all three tonsils is required.
The goal of removing all three tonsils is to eliminate problems caused by enlarged tonsils, improve the quality of life of the child, ensure normal development and a positive outcome for general health.
After the need for tonsillectomy is determined, it is necessary to prepare the child for the surgical procedure. We also advise parents to prepare, it is necessary to get as much information as possible about the procedure itself and care after tonsillectomy surgery.
We recommend that children explain what will happen at each stage of the process according to their age and ability to understand. The more a child understands why certain actions are being done, the less frightened and surprised he will be. Therefore, the whole operation will be less stressful.
At the Lohuis Filipović Polyclinic, we have gathered a team of top specialists who are especially dedicated to younger patients. We try to make their stay in our premises as pleasant as possible.
Our internationally recognized experts in pediatric otorhinolaryngology , in addition to extensive knowledge and experience, have a warm approach to all patients.
Before the procedure, it is necessary to perform certain blood and urine tests and consult an anesthesiologist. The test results must not be older than 2 weeks. If the child has allergies to certain medications, be sure to emphasize this during the examination by an anesthesiologist.
According to the severity of the procedure, the operation of all three tonsils is one of the less demanding surgical procedures. It takes about 60 minutes.
Tonsillectomy consists of two basic procedures: tonsillectomy (surgical removal of the palatine tonsils) +/- adenoidectomy (removal of adenoid vegetation) and bleeding control, homeostasis.
As tonsillectomy removal is a relatively simple procedure, we treat it as an outpatient procedure, since a longer hospitalization after the procedure is not necessary. In children, the procedure is performed under general anesthesia with sedation prior to the procedure.
The operation lasts on average about 30-60 minutes , and after waking up from anesthesia, the child is monitored for some time in a hospital setting.
If there are no complications after the procedure, primarily bleeding, the child can go to home care on the same day. At the Lohuis Filipović Polyclinic , we use modern surgical methods (ultrasound scissors, diode laser, CO2 LASER in combination with classical surgical methods and bipolar electrocoagulation) that ensure good results and help reduce postoperative pain.
Already 2 hours after the operation, it is necessary to start moisturizing – by giving lukewarm tea or boiled water.
In the period after the procedure, it is extremely important that the child drinks as much as possible, at least 2 liters of fluid per day.
This moisturizes the procedure site and activates the swallowing muscles. Proper hydration in the psotoperative period reduces the possibility of developing complications and ensures a quick recovery.
It is necessary to avoid eating too hot or too cold and to ensure optimal hygienic conditions.
Home care of the child after tonsillectomy removal requires the introduction of a special diet and the provision of appropriate hygienic conditions. Visits should be avoided in the postoperative period, the child should be at rest.
After the procedure, the soreness of the operated area is normal. Most often, children recover relatively quickly after the procedure, and the pain and discomfort last relatively short. Consuming enough fluids helps reduce pain and promotes wound healing.
You can give your child analgesics according to the doctor’s instructions.
After the removal of the tonsils, an open wound remains at the operated site. On the second day after the procedure, it will be covered with white deposits that disappear spontaneously between the fourth and eighth day.
The appearance of white deposits is not a sign of inflammation, but it is a normal healing process.
For the first 3 days after surgery, all three tonsils should drink a sufficient amount of fluids, 2 or more liters per day. You can give your child lukewarm tea without lemon, apple juice, milk and the like.
After the first two days, in addition to soft food, you can introduce soft food like pureed fruits and vegetables, biscuits soaked in milk, semolina cereal. After the fifth day, you can gradually return to your usual diet, first by introducing overcooked rice, pasta, minced meat and others.
It is necessary to avoid acidic foods, very spicy, too hot or too cold foods. It is also necessary to avoid particularly rough food that could irritate the operated area.
Immediately after tonsillectomy surgery, we instruct parents to insist on rest for a speedy recovery.
On the first and second day, children themselves are not prone to excessive activity as a result of the procedure and anesthesia.
It is also important to avoid visits because they are potential carriers of infection. Return to daily activities is expected approximately 2 weeks after the procedure.
The first few days after the procedure, children may have an elevated body temperature, 37.2 – 38.3 ° C. Fever is not a sign of concern unless it exceeds 38.8 °C and does not last longer than two consecutive days. To lower the temperature, you can use antipyretics such as Lupocet as directed by healthcare professionals.
It occurs due to the healing of the surgical wound and the cleaning of tissues.
For the first seven days after the procedure, it is not recommended to brush your teeth, but to consume enough fluids to help suppress bad breath. You can also buy a special mouthwash solution at the pharmacy or gargle lukewarm sage tea.
In the postoperative period, children often breathe through the mouth. Snoring may occur during sleep. We recommend using a suitable pillow, i.e. putting your head in a slightly elevated position.
In the first time after the procedure, the child speaks quietly or squeaky because it saves the voice. It is normal for changes in the voice to occur because the resonance space in which the voice is formed changes. Even after the wound has healed, it is possible that the child will have a slightly different timbre of voice.
Generally speaking, complications after surgery on all three tonsils occur in a rarer number of cases.
It is possible to experience side effects related to general anesthesia, which can be avoided by good communication with the medical staff and by mentioning possible drug allergies during consultations with a doctor.
Intraoperative bleeding can occur, which is controlled and stopped by ligation of blood vessels during the procedure itself.
If it occurs after the procedure, it is an emergency condition due to possible airway obstruction. In case of fresh blood in the mouth or vomit, a doctor should be contacted immediately.
They can occur in the first 6 hours after the procedure. If they occur after that and last longer, it is necessary to contact a doctor.
It represents a lack of fluid and electrolytes, and is manifested by the appearance of thirst, dryness of the mucous membranes, reduced urine excretion.
Most of the possible complications after surgery of all three tonsils in children can be prevented by simple procedures and following the instructions of the medical staff.
Among the factors in children’s recovery, parental care is the most significant. Insisting on rest, prohibiting visits and ensuring hydration will ensure a quick recovery of the child with minimal discomfort.
In case you need surgery or just suspect that something is wrong, do not wait – make an appointment for your child today by calling +3851 2444 646, or by filling out the online form.
The main goal of LF Polyclinic is to improve the quality of life and health of our clients by providing them with top-notch healthcare services.
