Palatine tonsils (glands) are the 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 refers to the first-line immune defense. These are the only tonsils that are available for inspection without the use of auxiliary tools.
The structure and functions of the glands
The lymphoid tissue of the glands forms folds called lacunae (crypts). The tissue of the tonsils has a porous structure. When pathogenic microorganisms get into the gaps of the glands, an inflammatory reaction begins, aimed at the destruction of foreign agents. As a result of this, pus accumulates in the gaps - exudate, consisting of dead microorganisms, white blood cells, desquamated dead epithelium of the tonsils. This pus can be seen when examining the tonsils in the form of traffic jams in gaps. At the same time, the tonsils themselves increase in size, become reddened and friable. 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 a person lies in its aggressive cardiotropic effect: a chronic focus of beta-hemolytic streptococcus is fraught with rheumatism and heart valve defects.
In some cases, chronic tonsillitis can be treated with medication, but if conservative treatment is ineffective, surgical intervention is necessary. Until recently, the most common operations in ENT practice on the 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 - lacunotomy, which is carried out using a laser, is gaining popularity.
The essence of the operation
Lacunotomy allows you to save tonsils and cleans their gaps 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 the trauma of surrounding tissues. Laser lacunotomy is also called molecular resonance destruction of the tonsils.
The essence of the operation is that under the influence of a high-frequency laser, coagulation of pathologically altered lacunae occurs together with their contents. After "evaporation", crusts (scabs) form on the surface of the tonsils, which are soon torn away, and scar tissue remains in their place. Over time, the scars epithelize, and the functions of the lacunae are fully restored.
In the glands after the operation, a sufficient amount of lymphoid tissue remains so that these small organs 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 significantly, which depends on the volume of the operation and the clinic that conducts it. 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
Laser lacunotomy surgery has many advantages over other types of operations on the tonsils:
- is organ-preserving;
- does not traumatize surrounding tissues;
- is bloodless;
- has high efficiency;
- Trades local anesthesia;
- does not take much time;
- possibly carried out on an outpatient basis;
- rarely there are complications;
- quick recovery.
Due to minimal trauma to the tissues of the tonsils surrounding the operated gaps, 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 lymphoid tissue, increasing its ability to regenerate, therefore, in comparison with classical surgical tonsillotomy, it is more preferable.
Like any other intervention in the body, laser lacunotomy has its drawbacks. Otorhinolaryngologists are considered its main disadvantage is the insufficient radicalism of the operation. This drawback is inevitable, since the lymphoid tissue in the tonsils persists, which in some cases causes a relapse of chronic tonsillitis. If, after lacunotomy, the disease recurs more than twice a year, this is the basis for repeated 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 radicalism, the disadvantages of laser lacunotomy include bleeding from injured tissues. This complication is rare, and its cause is a violation of the procedure or incorrect patient behavior during the early recovery period.
Indications and Contraindications
The main indication for laser lacunotomy is recurrent chronic tonsillitis. If exacerbation of chronic tonsillitis occurs more than twice a year, its conservative treatment is considered ineffective and surgery to exclude lacunae is recommended.
Indications for laser tonsillotomy are:
- tonsil hypertrophy (when they begin to interfere with swallowing and breathing);
- cicatricial and adhesive processes on the surface of the glands (they prevent the outflow of contents from the gaps);
- 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 from conservative treatment.
When prescribing a 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 heart and kidney diseases;
- severe diabetes mellitus;
- pathology of the blood coagulation system;
- malignant neoplasms.
In this case, the first three contraindications are considered relative and after normalization of the patient’s health, laser surgery on the tonsils can be performed. Lacunotomy is not recommended for pregnant women and children under 10 years of age.
Preparation for the procedure
In order for the operation to be successful, the patient must be properly prepared for it, and also eliminate the presence of contraindications. In addition to examining an otorhinolaryngologist, patients undergo laboratory tests (general and biochemical blood tests, immunograms, coagulograms, blood tests for hepatitis B and C, HIV, syphilis, a general urine test, bacterioscopic examination of a throat swab), as well as instrumental examinations (fluorogram, electrocardiogram ) If necessary, consultations are scheduled with doctors of other specialties (dentist, cardiologist, general practitioner, endocrinologist, gynecologist).
If the patient has any chronic diseases, they need to be treated. The operation can only be performed during the period of remission of chronic pathologies. Before lacunotomy, all carious teeth need to be treated as well, since carious cavities are a hotbed of chronic infection: after surgery on the tonsils, they can cause infectious complications.
The operation is minimally invasive, therefore it is performed in a special handling room, and not in the operating room. Before the intervention, the tonsils are irrigated with a local anesthetic solution, and if necessary, local anesthesia is infiltrated into the tonsils themselves.
After the anesthesia works, the doctor brings the laser manipulator to the surface of the glands, without touching them. Beam dissection of adhesions, scars and burning of pathologically altered tissues. During the operation, the patient smells burnt meat.
The total duration of the operation ranges from 10 to 20 minutes (depending on the size of the lesion area of the tonsils). After the intervention, hospitalization is not required. The patient should not eat food within 4 hours after the procedure.
In order for the wound surface of the tonsils to quickly clear of the scab and epithelize, the patient must behave correctly during the rehabilitation period.
The first day after the intervention of the patient will be disturbed by sore throat. This is a completely natural situation, because at the site of the laser remains a naked wound surface, 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 in the first days after the procedure is possible. You can solve the problem of fever using the same anti-inflammatory drugs that are prescribed for pain. Take antipyretic drugs (Paracetamol, Ibuprofen) should be when the patient's body temperature rises above 38 ° C. You should not fight with low-grade fever, as this is a protective natural reaction of the body to soft tissue injury.
From the first day, the wound surface of the tonsils begins to become covered with fibrous plaque, which gradually dries up and forms a crust (scab). Under the crust, a healing process takes place. You can’t remove this scab on your own: it is fraught with the formation of deep wounds on the tonsils. The scab goes off independently after 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 furatsilin, Lugol, chamomile, sage. You can absorb 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 a minimum quantity.
A week later, crusts begin to come off the surface of the tonsils. According to patients' reviews, many believe that they have begun exacerbation of chronic tonsillitis: the amount of discharge is increasing, and many plugs appear on the surface of the glands. 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 cleaned of purulent contents. The cleansing process lasts about a week.
2-3 weeks after laser lacunotomy, the glands become dense, clean, and decrease to normal sizes. Such changes indicate that the operation was successful.
During the entire recovery period, patients should regularly visit the attending physician to monitor the healing process.
Laser lacunotomy is a modern treatment for chronic tonsillitis. The operation is not radical, therefore, it cannot completely prevent the occurrence of exacerbations. To clear all problem gaps, with severe tonsillitis, ENT doctors recommend that patients undergo the procedure several times.
The otorhinolaryngologist should decide on the feasibility 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.