Tonsil surgery, or tonsillectomy, is surgery to remove the tonsils. Very common a few years ago, this operation is less and less carried out today.

The tonsil surgery involves removing the tonsils. As a reminder, the tonsils, or palatal tonsils, are two small round masses of about 2 cm, located at the back of the throat, at the level of the soft palate, on each side of the uvula. Formed of lymphoid tissue, their surface is dotted with small cavities, called tonsil crypts. The tonsils play a role in the immune system: they trap bacteria and viruses that can contaminate the inspired air or ingested food, and trigger the production of antibodies and lymphocytes to fight infections.

In children, hypertrophy of the tonsils is frequent and physiological. It results from an inflammatory reaction of an organism in the process of immune maturation. The volume naturally regresses as immunity is acquired.

Different situations can lead to proposing an ablation of the tonsils:

• obstructive hypertrophy of the tonsils interfering with breathing and swallowing, or even leading to obstructive sleep apnea syndrome (OSAS). This is the main indication today. This problem also occurs in children: 1 to 3% of children between 3 and 6 years old are affected, and 13% in cases of obesity. Because it causes poor quality sleep, OSA can affect children’s growth, neurocognitive development and behavior;
• recurrent tonsillitis (acute tonsillitis) (3 tonsillitis with pain and fever per year for two years in a row). In this indication, tonsillitis is today practiced with great circumspection, due to an unfavorable benefit / risk ratio;
• chronic tonsillitis (inflamed, tender tonsils that persist after 3 months of treatment);
• periodic fever, adenitis, pharyngitis, aphthosis syndrome (FPAPA) in children;
• a peri-tonsil abscess (or tonsil phlegmon);
• neoplastic pathology (lymphoma or rhabdomyosarcoma) of the tonsil.

Previously frequently performed in children, tonsillectomy is much less so today. In 2010, 35 tonsil operations were performed on children under 000, compared to 18 in 68 (000). 

The days following the operation

The operation will leave a wound on each side of the uvula that will take 8 to 15 days to heal. This wound will be covered with a whitish coating, often foul-smelling.

The post-operative consequences are mainly marked by pain in the mouth, throat and ears, pain whose intensity and duration vary from one patient to another. They generally last 5 to 15 days (3). From the recovery room, the pain, often intense, is due to the wound, then from the second day, it is the inflammatory reaction at the level of the tonsils which is at the origin of the persistent pain for several days. These pains can be increased when eating food. Analgesic treatment is therefore systematically prescribed.

At the same time, the cold, the mouthwashes with hydrogen peroxide, chewing gum, the pacifier (in children) temporarily reduce the immediate postoperative pain. Homeopathic intake of Arnica montana 30 Ch in combination with analgesic treatment reduces postoperative pain (4).

Diet after tonsil surgery

Even if swallowing is painful, it is recommended to resume an appropriate diet early in order to promote rapid recovery of swallowing. The first days, the food will be mixed and cold.

The risks

Besides the risks inherent in any surgery and general anesthesia, the main risk of tonsillectomy is bleeding. This risk is highest within 6 hours after the operation, hence increased monitoring in the hospital, then 6 to 10 days after the operation, when the “pressure ulcer fall”, that is to say say when the scab peels off and the wound heals. This is why it is imperative to remain at rest and to consult in case of bleeding.

Infectious pharyngitis and postoperative pneumonia can also occur.

The tonsil surgery takes place under general anesthesia with tracheal intubation. It is performed by passing the instruments through the mouth.

Two surgical techniques exist:

• the classic surgical dissection technique with cold instruments. The tonsil is cut off and the bleeding is controlled with ligatures or stitches;
• diathermy, which is the use of a high-frequency electric current to cut tissue, remove the tonsil, and control bleeding.

The literature review does not allow us to conclude that one of the methods is superior to the other (1).

In children, tonsillectomy is often associated with adenoidectomy, that is, removal of the adenoids.

Note that a technique of partial removal of the tonsils is sometimes practiced by some teams. The technique is under evaluation.