• Sampath Chandra Prasad Rao

Surgery of adenoids and tonsils:

Adenoids and tonsils are lymphatic tissue guarding the nasopharynx and oropharynx respectively. The play a very important role against infections. They trap bacteria and viruses and destroy them with the inherent immune mechanisms in the body. Adenoids tend to regress as age progresses and disappears by the age of 15 years. Tonsils are present throughout the life and tend to reduce in size but do not completely disappear.

Although adenoids and tonsils are useful in protecting the body against bacteria and viruses, they have a minor role in immunity as age progresses. They tend to cause significant morbidity in children and adults with recurrent infections. Enlarged adenoids and tonsils can cause obstructive sleep apnea. Adenoids can lead to eustachian tube obstruction which leads to reduced hearing due to accumulation of fluid in the middle ear. Enlarged tonsils can also lead to accumulation of pus in the space behind the tonsils leading to sepsis and spread of infection elsewhere in the human body. The above-mentioned reasons are indications for removal of adenoids and tonsils.

The surgical procedures for removal of adenoids and tonsils are termed as adenoidectomy and tonsillectomy respectively. Adenoidectomy was previously a blind procedure which used to be carried out through the oral cavity with a curette. In the current era, adenoids are removed under vision with the help of an endoscope. The advent of gadgets like microdebrider and coablator has enabled the ENT surgeons to render the blood loss negligible. The removal of tonsils can be performed similarly with the gadgets mentioned above. In addition , LASER can be used for removal of the tonsils. Both adenoidectomy and tonsillectomy surgeries are performed without external incisions or scars. Complications of adenoid surgery although negligible include intra- and post-operative bleeding, injury to the Eustachian tube, velopharyngeal insufficieny and Grisels syndrome. Complications of tonsil surgery although negligible include intra- and post-operative bleeding and injury to neighbouring structures like soft palate, uvula, tongue and teeth.

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