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Tonsillectomy Triumph

Each day I look at a lot of different teeth, as we all do as general dentists. In hygiene checks, not only do I check the health of the teeth, gingiva, and associated structures, but I also do an oral cancer screening and evaluate for airway problems. My interest with airway issues came not from CE classes, but from my own child. My daughter had Class IV tonsils--I honestly do not know how the child ate, breathed or functioned on a normal day! These two "boulders" were nearly kissing each other on a daily basis, and if she was sick, it was a miracle that there was any air exchange occurring at all. Not only this, but she was suffering from sleep apnea nightly, snoring (which her brothers teased her mercilessly about), and her orthodontic condition radically changed within 2 years to a full skeletal Class III malocclusion. As a rule, ENT doctors in my area, don't do much about this, unless there is frequent strep infections or (less importantly to them) a dental/orthodontic referral. Sleep apnea in children is rarely diagnosed. However, it can greatly destructive to children that are left undiagnosed. It can impede not only their physical development, but also causes fatigue, hyperactivity, cardiovascular problems, and behavioral problems, and many more issues in children afflicted by this. As if the sleep apnea was not enough of a problem for my daughter, her Class III orthodontic issues were another issue that resulted from the insufficient airflow into her body. Her own brain shifted her mandible forward in an attempt to open her airway. I battled to have the ENT address my concerns and be willing to move forward with the removal of these enormous obstacles to my daughter's development.

These are 3D CBCT images from Kallia's pre-op imaging radiographs. Holy cow, not a lot of room to exchange air, is there? I have one from the left side, middle and right side of her throat. It was notable that the sides had nearly zero air volume exchange (as indicated by the red shading). The direct center was a skinny zone of air exchange, but it is all red which is the lowest volume possible for an airway opening.

Although my battle to push this through was a much more personal, high-stakes game, this is oftentimes the cases in our offices when we recommend tonsils and adenoids be removed for dental or airway purposes. Many of us meet resistance and hesitance to perform this surgery.

Just remember, general dentists are on the front line of the battle to promote healthy dentitions, but also healthy airways. We need to check the oro-pharynx on all patients, not just for oral cancer concerns, but also for airway issues. Consider how you can impact your patients' lives by evaluating each airway you see, confidently referring to a like-minded ENT physician, and promoting healthy airway development along with healthy smiles!

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