Laser Tonsillectomy/Cryptolysis

by Dr. Christopher Chang, last modified on 3/18/21.

Please note, that we do NOT offer laser tonsillectomy in our office. Typically our office utilizes other non-laser methods like coblation cryptolysis.

Simply put, laser tonsillectomy is when the surgeon uses a laser beam to remove a part of the tonsil. Rarely, is an actual complete "tonsillectomy" performed in the traditional sense whereby the entire tonsil is completely removed. Instead, only the tonsil surface crypts/pits are removed or "resurfaced". Less commonly, an intracapsular tonsillectomy is performed during which the surgeon removes all of the tonsil except for a thin layer abutting the fossa where the tonsil sits inside the mouth.

At least in our office, we would ONLY perform a very limited surface crypt laser ablations and not an intracapsular laser tonsillectomy which we feel is too risky for possible severe bleeding. Also, laser is used in our office only when a few (<3) discrete spots on the tonsil require treatment. If the "entire" tonsil surface needs to be treated due to numerous cryptic lesions, coblation is used instead.

ADVANTAGES:

1) Can be done awake (without general anesthesia) in adult patients as long as there is:

minimal gag reflex
tongue is not large
tonsil can be visualized easily when opening the mouth

2) Less pain possible
3) Faster recovery than traditional tonsillectomy possible

DISADVANTAGES:

Along with risks of bleeding and dehydration found with traditional tonsillectomy, there are additional risks found when performing laser tonsillectomy including:

1) Airway fire (if a spark occurs due to laser use, it can ignite the air)
2) Blindness (laser can bounce off shiny surfaces like metal and reflect out)
3) Oral and facial burns (lasers do not burn just the tonsil, it can burn anything that gets in the way... in other words, do NOT turn your head, sneeze, cough, or gag if the laser is turned on!!!)
4) Continued problems with recurrent tonsillitis or strep throat (because in laser tonsillectomy, there's always some tonsil tissue left behind)
5) No pathology specimen to evaluate for lymphoma or tonsil cancer
6) Tonsil regrowth
7) There's some question whether there is an increased risk of life-threatening bleeding, mainly because the laser can pierce tissue like an arrow potentially. Not an ideal characteristic because the carotid artery is < 1 cm away from the tonsil. Read an article about a boy who died after laser tonsillectomy due to this complication.

Who is the ideal patient for laser tonsillectomy?

1) Adult patient
2) No gag reflex
3) Entire tonsil can be visualized when patient opens the mouth
4) Tonsil problems dealing mainly with tonsil stones or cryptic tonsils. Not chronic tonsillitis or strep throat.
5) No tonsil cancer concern

Great! I want a laser tonsillectomy! Who does them?

Here is a list of surgeons in the United States who also offer this procedure at this time that we are aware of. If you know of anybody else, email me and I would be happy to add to this list.

Kenny Chan, MD (Denver, CO)
Yosef Krespi, MD (New York City)
Edgar Ling, MD (New York City)
Haitham Masri (Dearborn, MI)
Jerald Giles (New Orleans, LO)

DID YOU KNOW that a person has a total of FOUR tonsils... one adenoid, two tonsils, and one lingual tonsil. The lingual tonsil is located on the back of the tongue. When lingual tonsils start to cause problems, they also can be removed.

If your tonsils and/or adenoids are affecting your quality of life, please contact our office for an appointment.

Links

Laser Tonsillectomy/Cryptolysis

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