Laser lacunotomy

Palatine tonsils (tonsils) are called accumulations of lymphoid tissue located in the oropharynx between the palatine arches. Their main task is to prevent the penetration of infection into the human respiratory tract. They are part of the pharyngeal lymphoid ring, which is the first line of immune defense. These are the only tonsils that are available for examination without the use of auxiliary instruments.

The structure and functions of the tonsils

The lymphoid tissue of the tonsils forms folds called lacunae (crypts). The tissue of the palatine tonsils has a porous structure. When pathogenic microorganisms enter the lacunae of the tonsils, an inflammatory reaction begins, aimed at the destruction of foreign agents. As a result, pus accumulates in the lacunae – an exudate consisting of dead microorganisms, leukocytes, and desquamated dead epithelium of the tonsils. This pus can be seen when examining the tonsils in the form of plugs in the gaps. At the same time, the tonsils themselves increase in size, become reddened and loose. This pathological condition of the tonsils is called chronic tonsillitis and requires the appointment of adequate treatment.

The most common causative agent of chronic tonsillitis is beta-hemolytic streptococcus. The danger of streptococcus for humans lies in its aggressive cardiotropic action: a chronic focus of beta-hemolytic streptococcus is fraught with rheumatism and valvular heart disease.

In some cases, chronic tonsillitis can be treated with medication, but if conservative treatment is ineffective, surgery is necessary. Until recently, the most common operations in ENT practice on the palatine tonsils were tonsillectomy (removal of the tonsils) and tonsillotomy (excision of the tonsils). Recently, a modern organ-preserving method of surgical treatment of palatine tonsils has become popular – lacunotomy, which is performed using a laser.

Essence of the operation

Lacunotomy allows you to save the tonsils and cleans their lacunae from pathological contents. The operation is performed on an outpatient basis, under local anesthesia. Most often, this manipulation is carried out using a laser beam, which minimizes trauma to surrounding tissues. Laser lacunotomy is also called molecular resonance destruction of the palatine tonsils.

The essence of the operation is that under the influence of a high-frequency laser, pathologically altered lacunae are coagulated along with their contents. After “evaporation”, crusts (scab) form on the surface of the tonsils, which are soon rejected, and scar tissue remains in their place. Over time, the scars are epithelialized, and the functions of the lacunae are fully restored.

After the operation, enough lymphoid tissue remains in the tonsils for these small organs to carry out their functions. The likelihood of recurrence of chronic tonsillitis is significantly reduced, since the focus of chronic infection is eliminated.

The cost of such an operation varies considerably, depending on the volume of the operation and the clinic that performs it. So, for example, in Moscow, laser lacunotomy in state and municipal medical institutions costs 3-8 thousand rubles, and in private clinics – 11-28 thousand. A similar trend is emerging in other cities of Russia (St. Petersburg, Rostov, Smolensk).

Advantages and disadvantages

The operation of laser lacunotomy has many advantages over other types of operations on the palatine tonsils:

• is organ-preserving;
• does not injure surrounding tissues;
• is bloodless;
• has high efficiency;
• requires local anesthesia;
• does not take much time;
• can be carried out on an outpatient basis;
• rare complications;
• fast recovery.

Due to minimal trauma to the tissues of the tonsils surrounding the operated lacunae, laser lacunotomy does not contribute to swelling of the tonsils. As a result, the drainage of normal lacunae is not disturbed, which reduces the risk of infectious postoperative complications. In addition, the laser has a stimulating effect on the lymphoid tissue, increasing its ability to regenerate, therefore, in comparison with the classical operative tonsillotomy, it is more preferable.

Like any other intervention in the body, laser lacunotomy has its drawbacks. Otorhinolaryngologists consider its main disadvantage to be the insufficient radicality of the operation. This deficiency is inevitable, since the lymphoid tissue in the tonsils is preserved, which in some cases is the cause of the recurrence of chronic tonsillitis. If after lacunotomy the disease recurs more than twice a year, this is the basis for re-excision of the tonsils or their removal (tonsillectomy). In most cases, the reviews of both patients and doctors about the results of the operation are positive.

In addition to insufficient radicality, bleeding from injured tissues can be attributed to the disadvantages of laser lacunotomy. This complication is rare, and its cause is a violation of the technique of the procedure or incorrect behavior of the patient during the early recovery period.

Indications and contraindications

The main indication for laser lacunotomy is recurrent chronic tonsillitis. If an exacerbation of chronic tonsillitis occurs more than twice a year, its conservative treatment is considered ineffective and an operation to excise the lacunae is recommended.

Indications for laser tonsillotomy are:

• hypertrophy of the tonsils (when they begin to interfere with swallowing and breathing);
• cicatricial and adhesive processes on the surface of the tonsils (they prevent the outflow of contents from the lacunae);
• the appearance of rheumatic pains in the joints, heart (even in the absence of organic lesions of these organs);
• acute rheumatism;
• peritonsillar abscess;
• frequent exacerbation of chronic kidney disease (pyelonephritis, glomerulonephritis);
• lack of effectiveness of conservative treatment.

When prescribing lacunotomy, the doctor should not forget that the operation has its own contraindications. These include:

• acute tonsillitis or exacerbation of chronic tonsillitis;
• high temperature in the patient;
• chronic diseases of internal organs in the acute phase;
• decompensated diseases of the heart and kidneys;
• severe diabetes mellitus;
• pathology of the blood coagulation system;
• malignant neoplasms.

At the same time, the first three contraindications are considered relative, and after the patient’s state of health is normalized, laser surgery on the tonsils can be performed on him. Lacunotomy is not recommended for pregnant women and children under 10 years of age.

Preparing for the procedure

For the operation to be successful, the patient must be properly prepared for it, as well as to exclude the presence of contraindications. In addition to an examination by an otorhinolaryngologist, patients undergo laboratory tests (general and biochemical blood tests, immunogram, coagulogram, blood tests for hepatitis B and C, HIV, syphilis, urinalysis, bacterioscopic examination of a throat swab), as well as instrumental examinations (fluorogram, electrocardiogram ). If necessary, consultations of doctors of other specialties (dentist, cardiologist, therapist, endocrinologist, gynecologist) are appointed.

If the patient has any chronic diseases, they need to be treated. The operation can be performed only during the period of remission of chronic pathologies. Before lacunotomy, it is also necessary to treat all carious teeth, since carious cavities are a focus of chronic infection: after surgery on the tonsils, they can cause infectious complications.

Operation technique

The operation is minimally invasive, so it is performed in a special manipulation room, and not in the operating room. Before the intervention, the patient’s tonsils are irrigated with a local anesthetic solution, if necessary, infiltration local anesthesia is performed into the tonsils themselves.

After the anesthesia takes effect, the doctor brings the laser manipulator to the surface of the tonsils, while not touching them. The beam dissects adhesions, scars and burns pathologically altered tissues. The patient smells burnt meat during the operation.

The total duration of the operation ranges from 10 to 20 minutes (depending on the size of the affected area of ​​the tonsils). After the intervention, hospitalization is not required. The patient should not eat for 4 hours after the procedure.

Rehabilitation period

In order for the wound surface of the tonsils to be quickly cleared of the scab and epithelialized, the patient must behave correctly during the rehabilitation period.

The first day after the intervention, the patient will be disturbed by sore throat. This is a completely natural situation, since the exposed wound surface remains at the site of the laser action, which is exposed to the action of digestive enzymes. To reduce pain, the patient is prescribed non-steroidal anti-inflammatory drugs that have a strong analgesic effect: Nimesulide, Ketoprofen, Ketanov.

Due to the ingress of protein coagulation products (after laser tissue treatment) into the bloodstream, an increase in body temperature is possible in the first days after the procedure. You can solve the problem of fever with the help of the same anti-inflammatory drugs that are prescribed for pain. Antipyretic drugs (Paracetamol, Ibuprofen) should be taken when the patient’s body temperature rises above 38°C. Subfebrile temperature should not be fought, as this is a protective natural reaction of the body to soft tissue injury.

Already from the first day, the wound surface of the tonsils begins to be covered with a fibrous coating, which gradually dries up and forms a crust (scab). Under the crust, the healing process takes place. It is impossible to remove this scab on your own: this is fraught with the formation of deep wounds on the tonsils. The scab comes off on its own in 6-7 days. To speed up the healing process of the wound surface, during the first week the throat must be treated with antibacterial and antiseptic solutions: irrigate with Bioparox, rinse with Miramistin, Chlorhexidine, solutions of furacilin, Lugol, chamomile, sage. You can dissolve lozenges with antiseptics (Faringosept, Septefril, Strepsils).

Food in the first postoperative days should be warm, but not hot, liquid or semi-liquid, not contain hot spices. Salt in dishes should be minimal.

A week later, crusts begin to peel off the surface of the tonsils. According to patients, many believe that they have an exacerbation of chronic tonsillitis: the amount of discharge increases, and many plugs appear on the surface of the tonsils. However, this exacerbation is false. In fact, the scab is rejected, the surface of the tonsils is exposed and the lacunae under the scab are cleansed of purulent contents. The cleansing process takes about a week.

2-3 weeks after laser lacunotomy, the tonsils become dense, clean, and shrink to normal size. Such changes indicate that the operation was successful.

During the entire recovery period, patients should regularly visit their doctor to monitor the recovery process.

Laser lacunotomy is a modern method for the treatment of chronic tonsillitis. The operation is not radical, therefore, it cannot completely prevent the occurrence of exacerbations. To clear all the problematic gaps, with severe tonsillitis, ENT doctors recommend that patients undergo the procedure several times.

An otorhinolaryngologist should decide on the advisability of performing laser lacunotomy, based on the results of an objective examination, data from laboratory and instrumental research methods, and the effectiveness of previous conservative therapy.