Fleximetalic tube for GA

Giving GA

Procedure under GA

Save your marriage

Laser surgery to cure snoring

Happy couples after laser

Surgeon and the CO2 Laser

Laser operation in the clinic

Laser surgery procedure

Laser Team

Laser Assisted Partial Turbinectomy under Local Anesthesia (LAPT)

Laser Assisted Uvulopalatopharyngoplasty (LAUP)

Snoring is due upper airway obstruction at nasal, nasopharyngeal and oropharyngeal airway. Common causes are enlarged Tonsil and adenoid, elongated uvula and soft palate, enlargement of toungue.This is seen more in obese patient.
Some people snore more when they have nasal congestion and cannot breathe through their mouth .Likewise; people who have deviated nasal septum or blocked nasal passages from other causes are more likely to snore. Sleeping flat on the back or drinking alcoholic beverages close to bedtime also induces snoring. Such situations may induce sleep apneas as well. A thorough evaluation and sleep study (Polysomnogram) can determine whether the snoring is associated with apneas and, if so, the severity of the sleep apnea.
One common surgery for snoring is the laser-assisted uvulopalatoplasty or LAUP a modification of the uvulopalatopharyngoplasty, or UPPP procedure. It is also performed for obstructive sleep apnea. In the LAUP, the surgeon uses a CO2 laser to cut away the uvula, the tissue that hangs from the middle of the back of the roof of the mouth (from the Latin word “uva” meaning “grapes”), part of the soft palate and part of enlarged Tonsils.

Some times more than one session may be needed.
Nasal surgery to remove obstructions in the nose or to correct a deviated septum may also be done. These are likely to treat snoring successfully when there is significant blockage in the nose and nowhere else. Other surgeries for snoring include major ones such as that to advance the jaw, tracheotomy, reduction tougue-glossectomy.

Laser-assisted uvulopalatoplasty: a less expensive alternative to older UPPP is laser-assisted uvulopalatoplasty (LAUP), which uses laser techniques to shorten the uvula and vaporize parts of your palate. Whereas UPPP is performed under a general anesthetic, LAUP can be done under local anesthetic if the patient is cooperating and have no gag reflex.. LAUP is easier to do if you’ve already had your tonsils removed.

Effectiveness: Majority of patients (80-90%) report reduction of snoring and improvement from sleep apnea.
Revision surgery might be needed in 10% cases after a year or two.

Diagnosing Tonsils and Adenoid

Examination of the tonsils by looking in the back of your child’s mouth using a light and mirror or a flexible telescope.
Your doctor may recommend a tonsillectomy if your child suffers from frequent bouts of tonsillitis or ear infections, or has breathing problems caused by swollen tonsils.
Xray of the Postnasal space shows enlarged adenoid.

Preop preparation

A tonsillectomy usually requires an overnight stay in hospital. If your child has a cold or infection in the week before the operation, please let your doctor know about it. The operation may need to be postponed until your child has fully recovered.
The operation is done under general anaesthesia. This means your child will be asleep during the procedure. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast.
The surgeon and anaesthetist will usually visit your child before the operation. Please tell them if your child has any allergies, loose teeth or any history of bleeding problems in the family.
You may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Operation

Most tonsillectomy operations are done in children under 15. The only effective treatment for recurrent and persistent tonsillitis is to have the tonsils removed. The tonsils will shrink in size as your child grows older, so an operation may not be necessary. Painkillers and antibiotics only provide temporary relief and are not used for long-term treatment. A viral infection won’t respond to antibiotics.
The operation usually takes about 30 minutes. There are several methods available for removing tonsils.

• Traditional Disection method - a special surgical blade is used to cut out the tonsils. Pressure is applied to stop the bleeding, and dissolvable stitches or heat is used to seal the wound.
• Laser Tonsillectomy

Post op period

Your child will be monitored and will need to rest on their side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick.
Your child may complain of a sore throat, earache and a stiff jaw. Pain relief and antibiotics are usually prescribed for a week .
You should encourage your child to drink and eat as soon as they feel ready, starting with clear fluids such as water or apple juice.
After about 12 hours, a white or yellowish membrane -slough - will appear where the tonsils were. This is nothing to worry about and is not a sign of infection.
Your child will usually be ready to go home the morning after the operation. Before you go home a nurse will give you a date for a follow-up appointment.

Recovering from tonsillectomy

Once home, follow the surgeon’s advice about pain relief. You can give your child painkillers such as paracetamol or ibuprofen syrup .Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.
If your child is prescribed antibiotics it’s important to finish the course.
Get your child to drink plenty of fluids and eat. It’s best to start with soft or liquid foods which are easier to swallow. Giving your child a dose of pain relief half an hour before meals may help make eating more comfortable. Encourage your child to brush their teeth thoroughly, at least twice a day.
Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.
If your child develops any of the following symptoms, please contact your doctor or the hospital immediately if any bleeding from the nose or throat or a high temperature
You can expect your child to make a full and quick recovery once the initial pain has resolved. Complete recovery can take two weeks.

Side effects?

Tonsillectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic. Common side-effects include:
• sore throat, earache and a stiff jaw - these side-effects may last for up to two weeks
• bad breath - this usually improves after two to three weeks
This is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Antibiotics are usually prescribed to help prevent infection.
Specific complications of tonsillectomy are rare but include:
• bleeding within 24 hours - your child may need to go back into theatre to have it stopped
• bleeding four to seven days after the operation (secondary haemorrhage) - this can be the result of an infection
• damage to the teeth or jaw - this can be caused by the instruments used to keep the mouth open during surgery
• chest infection and breathing problems - there’s a risk blood and tissue from the operation may get into the throat and down into the lungs

The adenoids are small pads of tissue found behind the back of the nose above the throat. They cannot be seen by looking in the mouth. Adenoids can become very large and block the eustachian tubes (the tubes from the middle ears to the back of the nose) and cause ear infections. Large adenoids can also block the nasal airway causing your child to breathe through his mouth and snore at night. Adenoids can become infected and carry germs (bacteria).

Your body can still fight germs without your adenoids. We only take them out if they are doing more harm than good.

Why take them out?

• Blocked-up nose: Very large adenoids can block the nasal passages. This causes snoring and keeps your child from being able to breathe through his nose. Severe blocking may lead to more serious problems (such as sleep apnea). Removing the adenoids lets the child breathe normally through the nose.
• Recurring ear infections: Very large adenoids can block the eustachian tubes and lead to ear infections or the failure of ear infections to clear. If a child has surgery to place Grommet tubes in the eardrums at the same time the adenoids are taken out, it can help prevent recurring ear infections.

What are the alternatives if the adenoids not removed?

Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time. Surgery will make these problems get better more quickly, but it has a small risk. You should discuss with your surgeon whether to wait and see, or have surgery now.

For some children, using a steroid nasal spray will help reduce congestion in the nose and adenoids, and may be helpful to try before deciding on surgery. Antibiotics are of little help and only produce temporary relief from infected nasal discharge. They have side effects and may promote bacteria that are resistant to antibiotics.

Have a second opinion

If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you.

Adenoid surgery-How it is done

Arrange for a week off school. Let us know if your child has a sore throat or a cold in the week before their operation - it may be safer to put it off for a few weeks. We often give a short course of antibiotics before the operation.

Your child will be put to asleep for the operation. We will take out the adenoids through his or her mouth, and then stop the bleeding before he or she is woken up.

In some hospitals, adenoid surgery is done as a day case, so that the patient can go home on the same day as the operation. Some surgeons may prefer to keep children in hospital for one night. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.

Most children need about a week off school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.

How long will it take to recover?

Most children are back to normal within 24 hours after surgery. Some children take a few days to recover. More snoring or nasal congestion is normal and is caused by temporary swelling in the back of the nose. Bad breath is also normal and is caused by the scabs that form after surgery. The snoring, congestion, and bad breath should be gone within 10 to 14 days after surgery.

Post operative Instructions after Adenoid Surgery

1. Pain Medicines

Most children have little pain after the operation. Most of the pain will be toward the back of the neck. Your child may have a sore throat for a few days. Give regular doses of pain medicine Like Paracetamol, syrup 4 to 5 times a day for a week. . You can also have your child suck on ice chips or chew gum.

A fever between 99°F (37.5°C) and 101°F (38.4°C) is normal for a few days after surgery and can be treated with Paracetamol. DO NOT USE ASPIRIN because this increase the chance of bleeding.

2. Antibiotics and decongestants are continued for another 5 days.

3. Diet

Begin giving your child cool, clear liquids as soon as she wants to drink. Gradually add foods that your child feels like eating until the diet is back to normal.
Your child may feel sick to her stomach, vomit, feel tired and cranky. This should get better within a few hours..

4. Activity

It is best for your child to rest at home for the first 3 to 4 days after surgery. Normal activities can start as soon as your child feels up to it. There is no rule for the right time to go back to school, but a guideline is 5 to 7 days. Your child should not play rough or play contact sports until 14 days after the surgery.

Possible complications

Adenoid surgery is very safe, but every operation has small risks. The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem.
During the operation, there is a very small chance that any loose tooth (milk tooth) may be removed to prevent aspiration.

Some children feel sick after the operation. This settles quickly.

A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks.

The child’s throat may be a little sore. Prepare normal food. Eating food will help your child’s throat to heal. Chewing gum may also help the pain.

Your child may have sore ears. This is normal. It happens because your throat and ears have the same nerves. It does not mean your child has an ear infection.

Give painkillers as needed for the first few days. Do not use more than it says on the label. Do not give your child aspirin - it could make your child bleed. (Aspirin is not safe to give to children under the age of 16 years at any time, unless prescribed by a doctor).