Tonsillectomy: Knowing options could help your child
After a 13-year-old California girl suffered devastating complications following a tonsillectomy in late 2013, we were reminded that all surgeries – even the most tried and true – carry some level of risk. That’s why doctors say it’s important to know your options.
Liz Gan, Archer’s mother: “The doctors, the pediatricians, every time I’d go they’d be like ‘Woah, you’ve got some big tonsils!’”
It was a procedure she saw coming — Liz Gan knew her son Archer’s tonsils would have to be removed.
Liz Gan: “He was an open-mouth breather both day and night. His sleep, you could hear him, just really heavy mouth breathing, and he would sleep fairly restlessly.”
And his speech had become garbled. Even his parents struggled to understand him.
Liz Gan: “As if his tongue had nowhere to go in his mouth.”
Archer had options. A full tonsillectomy was one of them.
Dr. Mark Gerber, otolaryngologist, NorthShore University HealthSystem: “The tonsils have a vascular pedicle that’s right in the middle of the tonsil, and in order to take that whole tonsil out you have to cut through that pedicle right at the capsule of the tonsil, so you’re baring those vessels there.”
Cauterizing helps control bleeding during the procedure – but otolaryngologist Mark Gerber says more commonly kids may bleed days later as the tissue heals. Two to four percent of total tonsillectomy patients have problems with delayed bleeding, and as many as eight percent of them require a secondary procedure to stop it.
Dr. Gerber: “When you have that bare muscle bed, and the scab falls off, all the blood vessels that are there underneath have that potential for breaking open again. It’s just like any other scab, if it comes off too soon you might have a little bleeding.”
There is an alternative. The intracapsular technique significantly cuts the risk of bleeding to less than one percent.
Dr. Gerber: “We’re actually shaving the tonsil from the inside out, leaving a thin rim of the tonsil tissue and underlying capsule which then acts like a biological band aid.”
The thin outer layer of tissue – called the capsule – protects delicate throat muscles from being exposed, reducing the need for pain medication and allowing patients to begin eating and hydrating sooner.
Dr. Gerber: “You still have the vessels coming through the capsule, but the capsule will constrict around the vessel, so it’s much less likely to bleed when the scab falls off.”
The idea appealed to Archer’s parents.
Liz Gan: “We figured, why not? Let’s go with the quicker recovery, less risk of bleeding and whatever could be better for Archer.”
Archer underwent the intracapsular procedure in December.
Liz Gan: “He had it on a Tuesday and by Thursday morning he was back at school. One of the moms in class, whose child also had his tonsils out with the full tonsillectomy, couldn’t believe her eyes.”
And the three-year-old’s parents couldn’t believe the dramatic change in their son’s breathing and sleeping.
Liz Gan: “Silent … to the point where my husband and I are like, ‘Is he okay in there?’”
Not so silent? Archer’s clearer speech.
Liz Gan: “I feel like it’s not only clearer to understand, but it’s also his voice changed for the better. I’ve got family out of town, and they’ve just heard him on the phone and they’re like, ‘He sounds different.’ You know, he’s so much clearer.”
Patients who undergo the intracapsular technique have a one in 500 chance their tonsils will grow back. Kids who get frequent strep infections aren’t the best candidates for the alternative procedure.