RU2069984C1 - Method for treating hypertrophic faucial tonsils - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing portions of hypertrophic faucial tonsils, which inferior poles are detected to be changed most of all. The operation is carried out on preschool age children. Hypertrophy of other region being observed (superior pole, median part of tonsil), these portions are to be also removed. Small portions are removed, but it is considered to be enough, for the subsequent cicatrix formation contributes to tonsil reduction in size. Saving tonsillectomy is carried out under anesthesia with tracheal intubation to exclude pharyngeal reflex and facilitate operative interference. Bochon loop for performing tonsillectomy is used for cutting-off hypertrophic portions of faucial tonsils in cases of saving tonsillectomy. The instrument is found to be less traumatic and more convenient as Matie tonsillectomy, especially during the first years of life. To remove insignificant portions of tonsilar tissues, Bruenings conchotome is preferential. EFFECT: enhanced effectiveness of method; improved functional results.

Description

 Surgical treatment of children with severe hypertrophy of palatine tonsils of the III degree consists in the targeted removal of individual, small in size, hypertrophic sections of the tonsils, which directly have a pathological effect on the child's body, causing difficulty in nasal breathing, impaired swallowing, nasal tone of speech, reflex cough, frequent diseases of acute respiratory infection. This method is gentle, since small sections of the tonsil tissue are to be removed, in the postoperative period minimal reactive phenomena are observed, due to which healing takes place in a shorter time, the anatomical structure and physiological function of the tonsils are not disturbed, and the development of chronic tonsillitis of a decompensated form is prevented.

 The invention relates to medicine, in particular to otorhinolaryngology, and is intended for the treatment of children with hypertrophy of the tonsils. The number of children with tonsils hypertrophy in recent years has a tendency to increase, while children develop various, most often bronchopulmonary diseases, respiratory allergosis, tracheitis, and recurrent bronchitis.

 The existing treatment for classical tonsillotomy is not without drawbacks. When clipping along the entire length of the hypertrophic palatine tonsil, a large wound surface with pronounced reactive phenomena is formed. Subsequent epithelization leads to cicatricial closure or a sharp narrowing of the lumen of the lacunae with a violation of their drainage function. The remaining infected part of the tonsil is encapsulated and inaccessible for the natural release of pathological secretions from gaps and for therapeutic effects by washing the gaps. Subsequently, in the absence of drainage, chronic decompensated tonsillitis is formed in the remaining tonsil tissue. This occurs due to the absorption of toxins and microbes from the inner sections of the tonsil tissue into the bloodstream.

 The aim of the invention is to preserve the anatomical structure, which allows the operated tonsils to continue to perform physiological functions, reduce treatment time and prevent the development of chronic inflammation in the remaining tonsil tissue.

 The first is achieved by the fact that the functionally most important part of the palatine tonsil, its upper pole with a well-developed system of gaps, in which vital protective immunological processes are carried out, remain intact. Only the lower pole is removed, which, on the contrary, is physiologically less important and, at the same time, in some patients it is the main obstacle to normal nasal breathing, the act of swallowing, speech impairment and, in some children, the cause of apnea. After removal of the lower pole and subsequent scarring in the area of the surgical wound, a shift of the upper pole down to the vacated spot is observed. The palatine tonsil takes the form of a small in size, normally located in a niche.

 The second reduction in treatment time is due to a less traumatic intervention technique. Instead of the Mathieu tonsillotoma, a Bohon loop designed for tonsillectomy is used. And also because small sections of hypertrophied tonsil are subject to removal in comparison with classical tonsillotomy.

 The third preservation of the system of gaps in the upper pole of the tonsils depends on the method of intervention described above, in which it is possible to limit the removal of the lower pole without touching the upper one. The mouths of the gaps in this case are intact and the drainage function is not disturbed.

 The method of gentle tonsillotomy is as follows. In preschool children with the presence of grade III hypertrophy, areas of hypertrophied palatine tonsils are purposefully removed, the lower poles look the most altered. In the presence of hypertrophy in other areas (upper pole, middle part of the tonsil), only these parts are removed. Small pieces of tissue can be taken, but this is enough, since subsequent scarring helps to reduce the size of the tonsils.

 Gentle tonsillotomy is always performed under anesthesia with endotracheal intubation. The use of anesthesia relieves the pharyngeal reflex, which facilitates the implementation of surgical intervention.

 To cut off hypertrophic sections of the tonsils with sparing tonsillotomy, a Bohon loop designed for tonsillectomy is used. Compared to the Mathieu tonsillotome, this instrument is less traumatic and more convenient when performing an intervention, especially in children of the first years of life. When removing small sections of tissue, the tonsils can be used with Brunings's conchot.

 The proposed method over the past 7 years (since 1985), 130 children underwent surgical treatment. An indication for sparing tonsillotomy was the anamnesis (frequency of acute respiratory viral infections, difficulty in nasal breathing, speech impairment, swallowing, and the absence of tonsillitis) and anatomical features allowing this sparing tonsillotomy to be carried out. Usually, tonsillotomy is combined with adenotomy, since hypertrophy of the tonsils is always accompanied by hypertrophy of the pharyngeal tonsil.

 The results of surgical treatment are as follows. According to follow-up data, after 3 to 5 years, the majority of children (92%) out of 50 examined showed a favorable effect. This was expressed in maintaining the size of the tonsils, restoring nasal breathing, reducing the frequency of acute respiratory viral infections, in the absence of tonsillitis and cases of the formation of chronic tonsillitis. In 8% of cases, children continued to have ARVI, tonsillitis and the result of sparing tonsillotomy should be considered unsatisfactory. However, this percentage is significantly lower than that observed when performing classical tonsillotomy. We have studied the long-term results of tonsillotomy (Journal of Otic Nose. Throat Bol. 1985, N 6, p. 27 30. “Long-term Results of Surgical Treatment of Children with Palatine Tonsil Hyperplasia” and works of the Leningrad Scientific Society of Pathologists. L: Medicine, 1985, issue 26, p. 123 125. "On histological changes in the tonsils in the long term after tonsillotomy"). It was found that the positive effect of tonsillotomy performed using the classical method was observed in 20% of cases. In 35% of children, 2–3 years after surgery, the formation of chronic decompensated tonsillitis took place, requiring repeated intervention of tonsillectomy.

 We give examples of a favorable outcome for sparing tonsillotomy.

 Example 1. Child R. 3 years. Due to a sharp difficulty in breathing through the nose, runny nose and frequent monthly repeated ARIs, a nasal shade of the furnace and sleep apnea, was operated on in 1987. Sparing tonsillotomy and adenotomy were performed. Sick from the first year of life. Objectively: with posterior rhinoscopy, adenoid growths of the III degree. Palatine tonsils are also enlarged to grade III. The upper poles on both sides are moderately hypertrophied and protrude into the lumen of the pharynx. The lower poles are much more hypertrophied, which descend into the larynx and are located close to the posterior pharyngeal wall, which causes difficulty breathing through the nose, especially in a horizontal position, and causes apnea at night.

 Within a year after the operation, nasal breathing was free, the nasal tone of speech disappeared, the child was ill once with acute respiratory infections. After the flu, nasal breathing and runny nose appeared. A purulent acute bilateral sinusitis was diagnosed, which stopped after appropriate conservative treatment. Over the next three years he was healthy, he did not get a sore throat, nasal breathing was free.

 Example 2. Girl A. 5 years. Due to a sharp difficulty in breathing through the nose, frequent acute respiratory infections, tracheitis and bronchitis, underwent adenotomy at the age of three. Tonsillotomy was not performed, since the tonsils were moderately hypertrophied (II degree). After an adenotomy, recovery of nasal breathing was practically not observed, the child often continued to suffer from colds and a runny nose. Objectively, pharyngeal tonsil hypertrophy was determined in the pharynx, especially their lower poles, which almost completely closed during phonation, closing the larynx. Surgery included repeated adenotomy and sparing tonsillotomy. The remains of adenoid tissue and the lower poles of the tonsils are removed. The lumen of the pharynx was restored, breathing became free. Control inspection after 3.5 years. The girl is healthy, occasionally has ARI, nasal breathing is free.

Claims (1)

 A method of treating hypertrophied palatine tonsils, based on gentle tonsillotomy, characterized in that they remove small altered sections of the palatine tonsils, most often the lower poles of the tonsils, cutting them off with the help of a Bohon loop.