What happened to the tonsils that required removal?

Because the tonsils are located in the deepest part of the human mouth and there are always residual bacteria in the mouth, they are easily infected, which will lead to the occurrence of chronic tonsillitis. The best treatment for chronic tonsillitis is surgical removal. Let's take a look at the operation process of tonsillectomy.

Tonsillectomy under local anesthesia

1. The patient usually sits, the surgeon sits opposite the patient, and the light source is at the side of the patient's head.

2. Injection of anesthetic

Take 20 ml of 1% procaine, add 4 to 6 drops of 1:1000 adrenaline solution and mix, then draw out half of the anesthetic with a 10 ml syringe, press down the tongue at the junction of the front 2/3 and the back 1/3 of the tongue with a tongue depressor to expose the pharynx clearly, and inject 3 to 4 ml of anesthetic into the upper, middle and lower parts of the palatoglossal arch respectively; first insert the needle tip into the submucosal membrane and inject a small amount, and then insert the needle tip along the periphery of the tonsils. The injected anesthetic, in addition to the anesthetic effect, can also separate the tonsils from the tonsillar fossa. A small amount of anesthetic should also be injected between the upper part of the pharyngeal palatine arch and the upper pole of the tonsil, and the opposite side should be anesthetized in the same way. At this time, the patient feels swelling in the throat and difficulty swallowing. After the injection, the surgery was performed 5 minutes later.

3. Incision

Use a tonsil knife to cut along the pharyngeal arch, 1 to 2 mm outside the free edge, from the upper pole of the tonsil downward to the root of the pharyngeal arch (), then bypass the upper pole, extend the incision, and cut the pharyngeal arch. However, care should be taken during surgery to ensure that the incision is not too deep and only the mucosa should be cut. If the cut is too deep, the superior pharyngeal constrictor muscles will be damaged. Or cutting into the tonsil tissue can easily cause bleeding and wound infection.

4. Remove the tonsils

Use a tonsil dissector to dissect the lingual palatine arch and the front of the tonsil from the incision of the lingual palatine arch, then press the upper pole of the tonsil downward, clamp the upper part of the tonsil with tonsil graspers, and at the same time press the tonsil downward with the dissector to separate it from the tonsillar fossa until a small pedicle is left at the lower pole. During the stripping, the stripper should not dig deep into the fossa to avoid damaging the superior pharyngeal constrictor muscles or blood vessels and causing bleeding.

5. Snare Removal

Insert the tonsil grasping forceps into the tonsil snare, clamp the tonsil with the tonsil grasping forceps and pull it inward and upward, while the snare is pulled outward and downward to wrap around the pedicle, tighten the snare, and remove the tonsil. Use tonsil hemostatic forceps to clamp a cotton ball and place it into the tonsil fossa to apply pressure to stop bleeding. At the same time, check whether the tonsils are intact and whether there is any tissue damage.

6. Check the wound

Use a tonsil retractor to pull open the palatoglossal arch and check whether there is bleeding in the tonsillar fossa and whether there is any residual tonsillar tissue, especially in the triangular folds at the inferior pole of the tonsil. There is a lot of lymphatic tissue. If it is not removed, it may still proliferate and hypertrophy after the operation, and even cause inflammation. In addition, the remnant at the lower pole can often cause postoperative bleeding. If there is active bleeding, it must be stopped properly.

Tonsillectomy under general anesthesia

1. Lie on your back and use a mouth opener to open your mouth so that the pharynx is clearly exposed. 1% procaine plus a small amount of 1:1000 epinephrine was injected submucosally into the palatoglossal arch and palatoglossal arch to achieve hemostasis. The specific operation of the surgery is the same as tonsillectomy under local anesthesia. However, the patient's head was inverted, so the direction of the surgery was opposite to that during local anesthesia.

2. During the operation, you should always keep your airway open to prevent suffocation. Hemostasis must be thorough to prevent postoperative bleeding.

3. After tonsillectomy, it is advisable to perform tonsillectomy with a tonsillectomy instrument and a tonsillectomy spoon, and use gauze to compress and stop bleeding.

Tonsillectomy can easily cause heavy bleeding, so the operator needs to be particularly cautious. After the operation, pay attention to whether the patient has other symptoms, such as fever or bleeding. The doctor needs to be informed in time, and the patient should eat liquid food during the recovery period to prevent hard food from causing damage to the wound.