What? Tonsillectomy is defined as the surgical excision of the palatine tonsils. Indications : Absolute Relative
Absolute Indications Recurrent infection of Tonsillitis causing Febrile throat : seizures 7 > ep. In 1 year or Hypertrophy of tonsils 5 ep. / year for 2 years or causing : 3 ep. / year for 3 years or Airway obstruction 2 weeks > of lost school or Difficulty in deglutition work in 1 year Interference with speech Peritonsillar abscess : Suspicion of malignancy In child - Done after 4-6 In unilaterally enlarge weeks after abscess has tonsil suspect lymphoma been treated in children and In adult - 2nd attack epidermoid carcinoma in adults.
Relative Indications Diphtheria carriers, who do not respond with antibiotics Streptococcal tonsillitis with bad taste or halitosis which is unresponsive to medical treatment Recurrent streptococcal tonsillitis in a patient with valvular heart disease.
The American Academy of Otolaryngology– Head and Neck Surgery (AAO-HNS) Paraphrased, these clinical Relative indications indicators are as follows: Three or more tonsil infections Absolute indications per year despite adequate Enlarged tonsils that cause upper medical therapy airway obstruction, severe Persistent foul taste or breath due dysphagia, sleep disorders, or to chronic tonsillitis that is not cardiopulmonary complications responsive to medical therapy Peritonsillar abscess that is Chronic or recurrent tonsillitis in a unresponsive to medical streptococcal carrier not management and drainage responding to beta-lactamase- documented by surgeon, unless resistant antibiotics surgery is performed during acute Unilateral tonsil hypertrophy that stage is presumed to be neoplastic Tonsillitis resulting in febrile convulsions Tonsils requiring biopsy to define tissue pathology
Contraindication Anemia (Hb ↓ 10g%) Acute infections Bleeding diathesis; leukaemia, purpura, aplastic aneamia, hemophilia Overt or submucous cleft palate Children < 3 years of age Uncontrolled systemic disease Tonsillectomy is avoided during the period of menses
Gradation of Tonsillar Enlargement
Anaesthesia Position Usually done under Rose’s position : General anaesthesia with Patient lies supine with endotracheal intubation. head extended by placing In adults it may be done a pillow under the under local anasthesia shoulders. A rubber ring is place under the head to stabilize it. Hyperextension should always be avoided
Techniques of tonsillectomyCold Methods Hot Methods Dissection and snare Electrocautery Guillotine method Laser tonsillectomy Intracapsular Coblation tonsillectomy tonsillectomy with debrider Radiofrequency Harmonic scalpel Plasma-mediated ablation technique Cryosugical technique
Steps of Operation (Dissection andSnare Method)1. Boyle Davis mouth gag is introduce and opened.It is held in place by Draffin’s bipods or a string over a pulleys.
2. Tonsil is grasped with forceps and pulled medially. Incision made in the mucous membrane.3. A blunt curved scissors may be used to dissect the tonsil from the peritonsillar tissue and separate its upper pole.4. Tonsil is held at its upper pole and traction applied downwards and medially or scissors until lower pole is reach.
5. Wire loop of tonsillar snare is threaded over the tonsil on to its pedicle, tightened.6. Pedicle is cut and the tonsil removed7. A gauze sponge is place in the fossa and pressure applied for a few minutes8. Bleeding points are tied with silk. Procedure is repeated on the other side
Post operative Care Immediate general care Keep patient in coma position until fully recovered from anaesthesia Keep watch on bleeding from the nose and mouth Keep check the vital signs (HR,RR and BP) Diet After fully recover ; cold milk or ice cream Sucking of ice cube gives relief from pain Gradually from soft to solid food. Plenty of fluids should be encourage
Oral Hygiene Pt. is given Condy’s or Salt water gargles 3-4 times a day Mouth wash with plain water after every feed Analgesics Warn patients that pain will abate during the first 3-5 days then increase for 1-2 days before completely disappearing Paracetamol can be taken to relieve pain Antibiotics A suitable antibiotics can be given orally or by injection for a week.
ComplicationsImmediate Delayed Primary heamorrhage Secondary Reactionary haemorrhage haemorrhage Injury to tonsillar Infection pillars, uvula, soft Lung complications palate, tounge or superior Scarring in soft palate constrictor muscle and pillars Injury to teeth Tonsillar remnants Aspiration of blood Hypertrophy of liangual Facial oedema tonsil