Instruments for adenotonsillectomy

1. Adenotonsillectomy
For AT & OT Students
Dr. Adhishesh Kaul

2. Procedure
• Surgery to remove adenoids and
tonsils from a patient
• Site
Adenoids: Nasopharynx –
Behind Nose
Tonsils: Oropharynx – After oral
cavity

3. Operative Procedure
1. Arrange the instruments
2. Position the patient
3. Prepare the patient
4. Surgeon operates

4. Positioning
• Shoulder Bag
• Head Ring

5. Operative Instruments - Basics
• Unolock Syringe – 2cc syringe with 26G (brown) long needle
• Lignocaine (2%) with Adrenaline
• Feeding tube/ suction catheter
• Syringes – 10CC/ 5CC
• Normal Saline
• Betadine and spirit
• Head drape
• Spinal needle
• Camera set
• Light source
• Gauze pieces
• Cotton Balls
• BP Handle
• Blade

6. Surgical Instruments

7. Boyle Davis Mouth Gag with Tongue Blade

8. Magauren Plate

9. Draffin Bipod

10. Look of the patient

11. St. Clair Thompson Adenoid Curette with cage

12. Steps for Adenoidectomy
• Position the patient – Rose position
• Using mouth gag, and draffin bipod : open the mouth
• If under vision – (using endoscope) : Some surgeons may infiltrate
adenoid tissue with 2% lignocaine with adrenaline
• Some surgeons may pass feeding tube from nose and pull out from
mouth to elevate the soft palate
• Using adenoid curette, shave the adenoids orally

13. Dennis Browne Tonsil holding forcep

14. Gwyne Evan tonsillar dissector

15. Mollison tonsillar dissector with pillar
retractor

16. Eve tonsillar snare

17. Yankauer suction tube

18. Steps of tonsillectomy
• Position the patient – Rose position
• Using mouth gag, and draffin bipod : open the mouth
• Infiltrate tonsils with lignocaine with adrenaline
• Pull the tonsils medially – using tonsil holding forcep
• Give an incision at mucus membrane where it reflects from anterior pillar
• Using pillar retractor and tonsillar dissector dissect the tonsils till lower
pole
• Using eve tonsillar snare, cut the tonsils
• Some surgeons may tie a knot before dissecting the tonsils

20. Newer Techniques
• Electro-cautery
• Laser Tonsillectomy
• Micro debrider assisted
• Harmonic scalpel
• Coblation tonsillectomy

26. Complications
• Hemorrhage /Bleeding
• Injury to adjacent structures – soft palate, uvula, tongue
• Injury to teeth
• Aspiration of blood
• Infection
• Scaring of soft palate
• Tonsillar remnants

27. That’s All for The Day
Thank You
Good Luck