Part 1

The Basics of Tonsillectomy

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What are the tonsils?

The tonsils are part of a group of glandular (lymphoid) tissue aggregations in the throat. The whole group together is called Waldeyer’s Ring, and as its name suggests, forms a ring of glandular tissue around the upper throat - surrounding the breathing and swallowing systems in the throat.

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The role of this glandular system is to identify unwanted substances such as bacteria or toxins, and to start producing antibodies to fight them as they go down into the body. The tonsils we think of when we get tonsillitis are the palatine tonsils - they sit either side of the palate in the back of the mouth. Other parts of Waldeyer’s ring include the adenoids, which sit behind the nose, the lingual tonsils on the back of the tongue, and posterior pharyngeal wall lymphoid aggregates, which sit on the very back wall of the throat. The palatine tonsils make up a variable percentage of the total amount of tissue in Waldeyer's ring, it probably averages about 50%.

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All of the glandular tissue in Waldeyer’s ring can get infected, causing a bad fever, sore throat etc. and there are operations to remove each area. The classic one is (palatine) tonsillectomy. Others include adenoidectomy, lasering of the posterior pharyngeal wall, and lingual tonsillectomy.

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What is tonsillectomy

'Tonsil-ectomy' means removal of the palatine tonsils. There are many different ways to remove tonsils, but basically all techniques can be separated into extracapsular (outside the capsule) and intracapsular (inside the capsule) removal.

 

Intracapsular removal is technically more difficult, and uses an operating microscope and vapourising laser in most situations. However it is associated with much less pain and bleeding risk postoperatively, although leaves a little tonsil tissue behind.

 

Extracapsular removal is the old fashioned technique where scissors or diathermy forceps are used to cut the tonsil away from the muscle of the throat.

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What is adenoidectomy?

The adenoids are lymphoid lumps that sit behind the nose. They make the nose very blocked, and can cause snoring. They are often removed at the same time as the tonsils in children, although by the age of 10 they usually shrink back, sometimes adults also need adenoidectomy.