This document discusses the management of tonsillitis, including both medical and surgical options. Surgical management involves tonsillectomy, which has absolute indications like recurrent infections or peritonsillar abscess, and relative indications such as being a carrier. Contraindications include anemia or bleeding disorders. The dissection and snare method is described, involving using a mouth gag, grasping the tonsil and cutting it out with a snare. Post-operative care involves a liquid diet, salt water gargles and analgesics. Other techniques like cold methods using guillotines or lasers and hot methods using electrocautery or radiofrequency are also mentioned.

1. Venkatesh Karthikeyan
III MBBS
Velammal Medical College
Email : 4852012@gmail.com

2. Management
 Medical
 Surgical

3. Medical management
 Usually in acute tonsillitis
 Treated with:
 Paracetamol (analgesia)
 Gargles of glycerol – thymol (soothing)
 Penicillin V
Ampicillin is avoided

4. Surgical Management
 Indications
 Contraindications
 Anaesthesia
 Position
 Steps of operation
 Post – op care

5. Indications
 Absolute
 Relative
 As a part of another operation

6. Absolute Indications
 Recurrent throat infection (7-5-3-14)
 Peritonsillar abscess
 Tonsillitis
 Hypertrophy of tonsils
 Suspicion of Malignancy

7. Relative indication
 Diphtheria carriers
 Streptococcal carriers
 Recurrent streptococcal tonsillitis in
patients with valvular heart disease
 Chronic tonsillitis with halitosis

8. As a part of another operation
 Palatopharyngoplasty (in sleep apnoea)
 Removal of styloid process (elongated –
recurrent cervicofacial pain – Eagle’s
syndrome)
 Glossopharyngeal neurectomy (for
cancer related carotid sinus syncope)

10. Contraindications
 Hb < 10g%
 Presence of acute infection in upper
respiratory tract (bleeding)
 Age <3
 Cleft palate
 Bleeding disorders
 Polio epidemic
 Co-morbidity
 Menstruation

12. Position for tonsillectomy

14. Steps of
operation

15. Dissection and Snare Method
 Boyle – Davis mouth gag is introduced
and opened
 It is held in place by Draffin’s bipods

16. Boyle Davis mouth gag

17. Draffin’s bipod

19. Grasp the tonsil with the tonsil
holding forceps

20. Pull the tonsil medially

21. Incise at the mucous
membrane where it reflects
from tonsil to anterior pillar

23. Wire loop of tonsillar snare is threaded
over the tonsil on its pedicle
Tightened
Pedicle cut
Tonsil removed

24. Tonsillar snare

26.  Place the gauze sponge in the fossa
 Apply pressure for few minutes
 Tie bleeding points with silk/cauterize
 Repeat the procedure on other side

27. Dissection and Snare
Method
 Boyle – Davis mouth gag – Draffin’s bipods
 Tonsil holding forceps – pull medially
 Incision
 Thread a wire loop of tonsillar snare over
tonsillar pedicle and cut it
 Remove the tonsil
 Gauze sponge – pressure – bleeding
control
 Repeat on the other side

28. Post operative care
 Immediate general care
 Diet
 Oral hygiene
 Analgesics
 Antibiotics

29. Immediate general care
 Recovery from anaesthesia
 Keep a watch on bleeding
 Monitor vitals

30. Diet
 Liquid diet
 Soft to solid foods on second day

31. Oral hygiene
 Salt water gargles 3-4 times a day
 Mouth wash with plain water after every
feed

32. Analgesics and antibiotics
 Paracetamol
 30 minutes before meal
 Avoid aspirin and ibuprofen
(Increases bleeding)
 Choose appropriate antibiotics

33. Other techniques of
tonsillectomy
 Cold method
 Hot method

34. Cold Method
 Guillotine method
 Intracapsular tonsillectomy with debrider
 Harmonic scalpel
 Plasma mediated ablation technique
 Cryosurgical technique

35. Hot method
 Electrocautery
 Laser tonsillectomy
 Coblation tonsillectomy
 Radiofrequency

37. References:
 Diseases of Ear, Nose and Throat – PL
Dhingra, 6th edition
 Short practice of surgery – Bailey &
Love – 26th edition
 www.ncbi.nlm.nih.gov

38. Thank you 