นวัตกรรมการผ่าตัดรักษาโรค “นิ่วต่อมทอนซิล“

Tonsil stones are a common condition found in the general population. Studies conducted in France indicate that this condition occurs in about 6% of the population.
How do tonsil stones form? Tonsil stones are living biofilms formed from the accumulation of debris such as food particles, saliva, and dead tissue from the tonsils in the tonsillar crypts. Various bacteria live together in a community, supporting each other, forming white lumps called Tonsil stones (Tonsillolith, Tonsil debris, Tonsil concretion). This characteristic causes tonsil stones to emit a foul smell of rotten egg gas (H2S) produced by the fermentation of Actinomycetes spp. bacteria.
Tonsil stones in the tonsillar crypts are a chronic condition if left untreated Tonsil stones occurring in the tonsillar crypts cause an infection and inflammation in the crypts (Tonsillar crypts infection). This is a type of chronic tonsil disease called Chronic cryptic tonsillitis. Medically, this disease is classified under “other chronic diseases of tonsils and adenoids” Diagnosis code J35.8 (2022 ICD-10-CM Diagnosis code J35.8). Tonsil stones cannot be cured with antibiotics because the biofilm is highly resistant to drugs, approximately 100-1000 times more resistant.
There are several surgical methods to treat tonsil stones The tonsils function to trap and destroy pathogens entering the throat and respiratory tract. This function lasts a lifetime but is especially important in children and young adults because tonsil function decreases with age.
Currently, the traditional treatment of tonsil stones by complete tonsillectomy has significantly decreased in developed countries such as the United States and Europe. Recent research reports that complete tonsil removal may cause more harm than benefit, potentially weakening the lungs and bronchi. People who have had their tonsils completely removed tend to get sick more often or more easily.
With advancements in surgical treatment for tonsil stones, it is now possible to treat without removing the entire tonsil. Partial tonsillectomy involves removing only part of the tonsil. The surgery can be performed at various levels, allowing doctors to choose the most appropriate method as follows:
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 1.Cryptolysis is the surgical procedure to dissolve or open the infected tonsillar crypts, removing accumulated debris or widening the crypt openings to prevent further accumulation of tonsil stones. Various tools can be used, including: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;1.1 Chemosurgery of tonsillar crypts (Chemical cryptolysis) involves applying 50-80% Trichloroacetic acid to the crypts and edges of the tonsillar openings after the doctor has scraped or suctioned out the tonsil stones. This procedure can be done in the examination room using topical throat anesthesia. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;1.2 LASER Cryptolysis uses CO2 LASER to surgically dissolve the deep tonsillar tissue containing the accumulated stones, smoothing the outer surface of the tonsils or making the crypts shallower and the openings wider to prevent further stone accumulation. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;1.3 Other Tonsil cryptolysis methods can be performed using various medical instruments such as RF, Electrosurgery (both Bipolar and Monopolar), Coblator, etc. Tonsil cryptolysis has limitations and cannot completely cure tonsil stones in one session. Studies abroad show that each cryptolysis session has about a 50-80% success rate depending on patient limitations, physician skill, and equipment used. Therefore, cryptolysis often requires 2-3 sessions or more. The advantages of this method include no need for general anesthesia, minimal blood loss (less than 1 cc), and high safety.
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 2.Tonsillotomy is the surgical removal of all debris from the tonsillar crypts (there are generally about 10-20 crypts in the tonsils). This surgery can be performed under local anesthesia.
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 3. Innovation Intracapsular tonsillectomy is a surgical method that can completely cure tonsil stones in a single operation by removing about 90-95% of the tonsil tissue while leaving 5-10% of healthy tonsil tissue to cover the tonsil capsule. This is a tissue-preserving tonsillectomy that retains the tonsil capsule and 5-10% of tonsil tissue to maintain tonsil function and preserve the throat structure, avoiding the structural weakening caused by traditional tonsillectomy.
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; This method is about three times safer than traditional tonsillectomy. It can be performed under general anesthesia using various instruments such as Electrosurgery, RF, Coblator, Microdebrider, or CO2 LASER. CO2 LASER surgery offers higher precision than other methods but must be performed by a surgeon specialized in CO2 LASER surgery.
<a href="../../doctor_detail/39533/%E0%B8%99%E0%B8%9E.%E0%B8%AA%E0%B8%A3%E0%B8%B1%E0%B8%A5%E0%B8%8A%E0%B8%B1%E0%B8%A2__%E0%B9%80%E0%B8%81%E0%B8%B5%E0%B8%A2%E0%B8%A3%E0%B8%95%E0%B8%B4%E0%B8%AA%E0%B8%B8%E0%B8%A3%E0%B8%B0%E0%B8%A2%E0%B8%B2%E0%B8%99%E0%B8%99%E0%B8%97%E0%B9%8C">[base64_img]</a>
<a href="../../doctor_detail/39533/%E0%B8%99%E0%B8%9E.%E0%B8%AA%E0%B8%A3%E0%B8%B1%E0%B8%A5%E0%B8%8A%E0%B8%B1%E0%B8%A2__%E0%B9%80%E0%B8%81%E0%B8%B5%E0%B8%A2%E0%B8%A3%E0%B8%95%E0%B8%B4%E0%B8%AA%E0%B8%B8%E0%B8%A3%E0%B8%B0%E0%B8%A2%E0%B8%B2%E0%B8%99%E0%B8%99%E0%B8%97%E0%B9%8C">Dr. Saranchai Kiatsurayanont</a> Specialist in Otolaryngology and Facial Plastic and Reconstructive Surgery For more information, please contact Ear, Nose, and Throat Center Phyathai 3 Hospital, 4th Floor Tel. 02-467-1111 ext. 4416 – 4417

The tonsils are important and beneficial. Surgery for tonsil stones has a new option that does not require complete removal of the tonsils, which we call Partial tonsillectomy.

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