Coblation Adenotonsillotomy

Introduction

Coblation Adenotonsillotomy is a subtotal removal of the tonsil and adenoid tissue. It has the advantage of being less painful than a traditional tonsillectomy with all the same benefits for sleep apnoea. The risk of bleeding is lower which is especially helpful with young children.

Indications

The primary indications for Coblation Adenotonsillectomy are;

  • Obstructive Sleep apnoea.
  • Recurrent tonsillitis / Sore throats.

This is Dr Morrissey’s preferred technique for all children under 3 years of age and where the main reason for surgery is snoring or sleep apnoea.

Risks

Coblation Adenotonsillectomy carries the same general risks as all operations including:

  • Pain.
  • Bleeding.
  • Infection.
  • Scarring.
  • Failure to resolve symptoms.

The main significant risk of Coblation Adenotonsillectomy is delayed bleeding, which may occur up to 2 weeks after surgery. It is a relatively rare complication from this form of surgery and is seen in approximately 1 in 500 cases.

Treatment Alternatives

There may be treatment alternatives suitable to you or your child that you can discuss with Dr Morrissey. Recurrent infections may respond to antibiotics in some cases while nasal sprays may assist in obstructive sleep apnoea in limited cases.

Preoperative Instructions

Coblation Adenotonsillectomy is performed under a general anaesthetic. You will need to fast prior to surgery and should follow the provided instructions. If you have any queries or concerns please contact your Anaesthetist, admitting hospital or Dr Morrissey.

Procedure

Under a general anaesthetic the adenoids are removed from behind the nose with a special instrument known as a coblation wand. Pressure or cautery is applied to control bleeding.

The tonsils are also removed using the coblation wand and any bleeding is addressed using stitches and/or cautery.

Postoperative Instructions

Return to normal activities

It takes around 7 days for most children to fully recover. You will need to keep your child away from day-care, kindergarten and school during this period.

General activities can be resumed when your child feels up to it. Please avoid active sports, rough play & heavy lifting for 2 weeks.

Pain relief

Children will experience throat pain and discomfort for up to 10 days following surgery.  Ear pain, jaw pain and neck pain may also occur. This can be improved with pain relief but may not entirely disappear. During this time, it is recommended your child take some regular pain relief.

Medications

  • Panadol every 4 to 6 hours (with a maximum of 4 doses in a 24hr period), continue this regularly for 5-7 days.
  • If your child refuses oral pain relief medication, Panadol can be given as a suppository.
  • Ibuprofen (Nurofen) up to four times a day as needed when pain is not controlled by panadol. Dosage per manufacturer’s instructions.

If pain relief requirements exceed this, please contact Dr Morrissey.

Non- Medication pain relief

There is some evidence that the following measures may aid in pain relief after tonsil surgery:

  • Maintain hydration to keep the mouth moist.
  • Use chewing gum / chewy lollies to exercise the jaw. It works like physio for your mouth.
  • Ice blocks, Ice cream and cool items can alleviate pain in the first few days after surgery.
  • A varied diet including some harder to swallow items (Bread / Meat / Apples and whole fruit) speed up the healing process by “cleaning” the operation site.

Antibiotics

In certain circumstances, children may be prescribed antibiotics following surgery. Please take as instructed if advised. For most children after adenotonsillectomy they are not needed.

Diet

There are no restrictions on diet. Children are encouraged to drink as much as required to avoid dehydration. Icy poles and paddle pops are a good option as they are cold, have good calories and contain fluid.

If your child refuses solids but is maintaining good fluid intake, this is acceptable.  At least 80mls per kg body weight per day is recommended.

Please contact Dr Morrissey if your child is not drinking or eating enough. They may need to be re-admitted to hospital for intravenous fluids.

Fever

It is common to have a mild fever for the first 24-48 hours after the operation.  Please call Dr Morrissey’s rooms or see your GP if there is a persistent fever greater than 38.5°C.

Bad Breath

This is expected following removal of the tonsils and adenoids and is part of the normal healing process. The bad breath usually settles after around 3 weeks if not sooner.

Bleeding

If there is any sign of fresh bleeding from the nose or mouth greater than a teaspoon in volume please present to the nearest Hospital Emergency department for assessment.

Follow Up appointment

A follow up phone call is usually made 4-6 weeks after surgery in most cases. Where an appointment is needed you will be advised by Dr Morrissey. If at any stage, you wish to see Dr Morrissey his staff will be happy to arrange an appointment.

How to contact Dr Morrissey

For non-emergency issues please call (07) 4646 4275 for further instructions.

Dr Morrissey shares ‘on-call’ arrangements with other ENT surgeons and one is usually available to answer questions. After hours the “on call” ENT surgeon can be contacted via the Toowoomba Base Hospital on (07) 4616 6000.

Should your concerns not be addressed via a phone call, please present to your nearest Emergency Department.

In the event of an Emergency call 000 or attend the nearest Emergency Department.

Related Information

Tonsillitis
Snoring and Sleep Apnoea