Mouth and Pharynx
The inflammation of the palatine tonsils (tonsillitis or angina) is still frequently treated by the tonsil ablation (tonsillectomy). Yet, it is necessary to examine meticulously in every single case, whether recurrent infections, a persistent chronic inflammatory affection or the suspicion of a different tonsil disorder really justifies the tonsil ablation.
Enlarged tonsils (tonsil hyperplasia) in children are often the reason for such a surgical intervention, if the swollen tonsils - mostly coinciding with enlarged pharyngeal adenoids - obstruct the ventilation canal of the middle ear, thereby causing hearing problems. Although the complete tonsil ablation has been the common practice for decades, we prefer meanwhile the reduction of the size of enlarged tonsils through the partial “erosion” of the tonsillar tissue by means of the radio frequency treatment (tonsillotomy). Compared with the older methods, consisting in the complete tonsil removal (tonsillectomy), this approach has the advantage of causing generally minor postoperative pain to the children, of reducing the risk of postoperative haemorrhage and of requiring a considerably shorter stay in hospital. Moreover the tonsillar tissue, being potentially important for the development of the child’s immune system, is partially preserved.
THE SALIVARY GLANDS
Swellings and pain in the area of the salivary glands (parotid gland, submandibular gland) can be due to various causes. Apart from different inflammatory disorders (for example mumps), which can be treated with medicaments, there are frequently benign tumours, which can only be removed by a surgical intervention. Performing an operation of the parotid gland, the surgeon must be extremely careful in order to avoid damages to the facial nerve which crosses the gland. The use of monitoring devices to visualize the path of the nerve as well as the use of microscopes and of finest surgical instruments are important precautions to prevent an irremediable damage to the facial nerves.
Sometimes small stones form for still unknown reasons in the salivary glands or in their duct system. Becoming larger and larger by the time, the stones eventually obstruct their ducts. This can cause sudden swellings of the affected gland and considerable pain. Finally, in the long-term, a serious chronic inflammation of the gland may arise.
removal of the salivary stones
Most frequently stones can be found in the submandibular gland, whereas they occur rather scarcely in the parotid gland. The stones lingering close to the mouth of the secretory duct can be removed in an outpatient surgical procedure by a small cut (duct incision) to enlarge slightly the orifice. Yet, it is also possible to insert a tiny endoscope in the duct system in order to visualize and to remove smaller stones. Frequently, even stones lingering deeper in the duct system can be eliminated with finest microsurgical instruments. This procedure enables the surgeon moreover to detect potentially other causes for the secretion disorders affecting the salivary gland. The surgical approach may prove more difficult when the stones lie deeper in the duct system or in the gland. In such cases good results have been obtained with the extracorporeal shock wave treatment (lithotripsy). In this therapy method the stones are first located by means of an ultrasound scan (sonography) and then destroyed with shock waves. The residual smaller stone particles are afterwards evacuated naturally together with the saliva. Although this therapy requires several treatment sessions, it causes all in all less discomfort to the patient.
The complete ablation of the gland is only necessary, if the salivary stones cannot be eliminated by one of the abovementioned procedures. Yet, this is not a big surgical procedure, either, since it requires only an incision of some centimetres below the mandible.
SWALLOWING DISORDERS DUE TO DIVERTICULA
A Zenker-diverticulum is a pharyngeal pouch at the level of the larynx which can cause swallowing problems. If such a diverticulum exists, food particles accumulate in the outpouching and are regurgitated into the mouth after a short time. Since this trouble usually aggravates by the time, a surgical intervention eventually may become necessary.
The natural evacuation of the food from the diverticulum into the gullet can be restored by a cut through the outpouching, which can be performed elegantly with an endoscope without external incision. The cut through the diverticulum is carried out with an endoscopic laser under microscopic monitoring. Normally, the patients can already leave hospital a few days after the surgery and don’t suffer any more from postoperative discomfort.
23.03.2014Big International Rhinoplasty Summit, March 2014 in Munich
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