All people have tonsil tissue on the back of the tongue (lingual tonsils) that is different from what we normally think of as tonsils (palatine tonsils) that are located on the sides of the throat and seen when we open our mouths. In some cases, substantial enlargement of the lingual tonsils contributes to airway blockage and obstructive sleep apnea. Lingual tonsillectomy involves removal of the bulk of the lingual tonsil in order to enlarge the airway behind the tongue. This procedure is performed in the operating room under general anesthesia, and it is performed by working through the open mouth without any external incisions.
Dr. Kezirian has written on his blog about lingual tonsillectomy and research demonstrating its role in the treatment of obstructive sleep apnea.
Preoperative: enlarged lingual tonsil
Postoperative: lingual tonsil reduced in size
As with any procedure, there is a risk of bleeding. Bleeding in this area can be serious and life-threatening. Fortunately, this is uncommon, and usually there is only minor oozing or blood-tinged mucus. A major factor in preventing serious bleeding is to avoid the use of aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for three weeks before and after surgery.
To reduce the risk of infection, an oral antiseptic rinse is used—and anitibiotics given—prior to the procedure. With these precautions, the risk of infection is low, but tongue infections can also be serious and life-threatening.
Tongue numbness or tingling
There is a nerve (lingual nerve) that is responsible for the senses of touch and taste for the tongue. Lingual tonsillectomy involves use of a unique type of radiofrequency (heat) energy on the tongue, and this can produce nerve damage. This nerve is located within the bulk of the tongue along the sides, and therefore lingual tonsillectomy is performed more thoroughly in the central part of the tongue. If nerve damage or these symptoms do occur, usually the damage is temporary with recovery over the course of days or weeks, but the damage can take months to recover or be permanent.
Tongue weakness or trouble swallowing
A second nerve (hypoglossal nerve) on each side of the tongue is responsible for tongue movement. It also can be injured during lingual tonsillectomy, but the same precautions reduce the risk of injury as for the lingual nerve (described directly above). The tongue is important for swallowing and either nerve injury or the swelling that occurs after a tongue procedure can present some difficulty with swallowing. a If damage does occur, this should recover over the course of days or weeks, but the damage can take months to recover or be permanent.
Operating in the back of the throat is impossible unless an instrument is placed to keep the mouth open. This is the same instrument used when tonsillectomies are done. Rarely, a tooth may be injured by this instrument, and the risk is much higher if a tooth is loose or decayed prior to surgery.
Need for additional procedures
Lingual tonsillectomy may not be effective in accomplishing the goals of surgery. Another procedure—either performed on the tongue region or on another area—may be necessary.
You should be prescribed narcotic pain medication. Take this medication as you need it for pain control, and try not to let the pain increase until it becomes intolerable before you take the medication. If you prefer to avoid narcotics, you should feel free to use acetaminophen (Tylenol®). Avoid aspirin, NSAIDs (such as ibuprofen, Advil®, Motrin®, naproxen, or Aleve®), vitamin supplements, or herbal medications for at least two weeks because they can increase your risk of bleeding after surgery. Your pain may be significant for the first 1-2 weeks following surgery, but it should improve markedly by the end of two weeks following surgery.
Due to a combination of pain and swelling that is to be expected, you may have some trouble swallowing. This may be either a difficulty in getting food to go down your throat or having liquids “go down the wrong way” into your windpipe (trachea), with coughing as a result. During your recovery, be careful with eating and drinking. You will most likely be able to eat your normal diet, but you should avoid excessively hot (temperature) foods for three days following the procedure because these can increase swelling.
You will be prescribed an antibiotic to take for several days. This can be useful for preventing infection and decreasing swelling. Take the antibiotics as directed. If you develop a rash or diarrhea (possible risks of antibiotics and other medications), stop the antibiotics and contact your doctor immediately.
Minimize strenuous physical activity for two weeks
At a minimum, patients should walk at least three times a day starting the day after surgery. Walking and spending more time out of bed (walking or in a chair) rather than in bed are helpful because they reduce the risks of developing pneumonia or blood clots in the legs. However, patients should avoid strenuous activity because it typically raises heart rate and blood pressure. For this reason, it can increase swelling or cause bleeding to start.
Sleep with head elevated (at 45 degrees) for at least three days
Elevating your head during sleep decreases blood flow to the head and neck regions. Therefore, it decreases swelling and the associated pain. Elevating the head during sleep may also improve breathing patterns in other ways. Therefore, we recommend elevating your head during sleep at 45 degrees for at least three days following the procedure.
NOTIFY DR. KEZIRIAN IMMEDIATELY IF YOU HAVE ANY TROUBLE BREATHING OR IF ANY BLEEDING DEVELOPS!