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Amigdalas
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Amigdalas

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Las amígdalas son un acúmulo de tejido linfático situado a ambos lados de la garganta, que intervienen en la lucha contra la enfermedad en etapas tempranas de la vida. No obstante, las amígdalas pueden ser a su vez causa de enfermedad crónica y dejar de tener esta misión que se les atribuye. Se convierten entonces en una fuente de problemas que pueden repercutir en todo el organismo.
 
 

 ¿CUANDO ES NECESARIA UNA AMIGDALECTOMÍA?

La cirugía de las amígdalas es necesaria cuando el tratamiento de la amigdalitis recurrente con medicamentos y otras medidas de soporte no es eficaz. Se suele realizar junto con la adenoidectomía (extirpación de las vegetaciones adenoideas). Aunque la indicación de realizar cirugía o no siempre es individualizada para cada paciente, hay una serie de indicaciones genéricas como son:

Cuando el gran tamaño de las amígdalas junto con el de las adenoides interfiere con la respiración provocando pausas de apnea durante el sueño, o interfiere con la alimentación correcta.
Cuando hay infecciones recurrentes de garganta. Si en un periodo de 2 años, un niño ha tenido de 3 a 5 brotes de amigdalitis anuales, el especialista en otorrinolaringología (ORL) podría valorar la posibilidad de una amigdalectomía, sobre todo si persiste la presencia de estreptococo beta hemolítico del grupo A en los cultivos realizados a pesar del correcto tratamiento antibiótico.
Cuando con anterioridad se ha tenido un absceso periamigdalar, ya que es habitual que recidiven, pudiendo ser cuadros de potencial gravedad.
Cuando la amigdalitis es causa de convulsiones febriles.
Si el tamaño amigdalar favorece la producción de otitis, o rinitis de repetición.
 
 PROCEDIMIENTOS DE LA OPERACIÓN DE LAS AMÍGDALAS

Antes de la intervención se hace un estudio preoperatorio.
Las ocho horas anteriores a la intervención el niño debe permanecer en ayunas.
La amigdalectomía se hace bajo anestesia general, en un quirófano, con un anestesista que monitoriza en todo momento las constantes vitales del niño. La intervención dura alrededor de unos 20 minutos.
El cirujano extrae las amígdalas del niño a través de la boca, sin realizar incisiones en la piel. La operación se realizara con instrumentos específicos, que disecan las amígdalas extrayéndolas del lecho amigdalar. El sitio de donde las amígdalas han sido extraídas cicatriza por si mismo en 10-14 días.
En la mayoría de los casos el tiempo de estancia en el hospital es de 5 a 10 horas. Niños menores de 3 años o con enfermedades crónicas permanecerán en el hospital al menos 24 horas. Al alta, el otorrinolaringólogo indicará tratamiento antibiótico y analgésico.
 
  CUIDADOS TRAS LA INTERVENCIÓN

Tras la operación de amígdalas, aparecen en la zona de la intervención unas costras blanquecinas. Estas costras no son signo de infección, sino la evolución normal de la cicatrización de la mucosa faríngea. Se debe tener mucho cuidado en que estas costras no se desprendan bruscamente para evitar el sangrado. Por ello, es conveniente:

Reposo relativo tras la amigdalectomía, evitando los ejercicios bruscos.
Evitar las maniobras en la boca que puedan llevar al desprendimiento de las costras (higiene dental posterior, colutorios enérgicos, etc.)
Seguir una dieta blanda fría durante dos días, que luego se hará tibia hasta pasado el séptimo día en que se comenzará con dieta normal.
Hay medicamentos como la aspirina que interfieren con la coagulación, procurar evitarlos antes y despues de la intervención.
 
  RIESGOS DE LA AMIGDALECTOMÍA

Riesgo anestésico, igual que cualquier otra operación. Afortunadamente, gracias a las medidas de control y los nuevos fármacos anestésicos, este riesgo es mínimo.

Sangrado del lecho amigdalar. Se puede producir inmediatamente tras la intervención o alrededor del séptimo día de la operación, cuando la escara que cubre la zona operada se cae. Está complicación puede minimizarse siguiendo las recomendaciones de su otorrinolaringólogo para el postoperatorio. Cuando la hemorragia ocurre la mayoría de las veces es escasa y cesa espontáneamente.

Dolor intenso de garganta durante la deglución, a menudo irradiado a oídos. Es pasajero y suele responder al tratamiento analgésico.

La amigdalectomía no parece influír de forma negativa en la respuesta inmune (defensas) del organismo. La función de las amígdalas es suplida íntegramente por el resto de los tejidos linfáticos del organismo.
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