Tonsillectomy-topic from dhingra

1. TONSILLECTOMY
PREPARED BY:
ADARSHLAL DIVAKARAN
AZEEZIA MEDICAL COLLEGE
KOLLAM

2. INDICATIONS OF
TONSILLECTOMY
 DIVIDED INTO 3:
1.ABSOLUTE.
2.RELATIVE.
3.AS A PART OF ANOTHER OPERATION.
WHAT IS TONSILLECTOMY?
TONSILLECTOMY IS DEFINED AS THE
SURGICAL EXCISION OF PALATINE
TONSILS.

3. 1.ABSOLUTE
Recurrent infections of the throat.
Peritonsillar abscess.
Tonsillitis causing febrile seizures.
Hypertrophy of tonsils causing
-airway obstruction
-difficulty in deglutition.
-interference with speech.
Suspicion of malignancy:unilaterally enlarged tonsil-
lymphoma in children/epidermoid ca in adult.

4. 2.RELATIVE
Diptheria carriers who do not respond to antibiotics.
Streptococcal carriers, who may be source of infection
to others.
Chronic tonsilltis with bad taste or halitosis which is
unresponsive to medicines.
Recurrent strep tonsillitis in pts with valvular heart
disease.

5. 3.AS A PART OF OTHER OPERATION
 Palatopharyngoplasty which is done for sleep apnoea
syndrome.
 Glossopharyngeal neurectomy.Tonsil is removed first
and then IX nerve is severed in the bed of tonsil.
 Removal of styloid process.

6. CONTRAINDICATIONS
 Hb level less than 10 g%.
 Presence of a/c infection in URI.
 Children under 3 yrs of age.
 Overt or submucous cleft palate.
 Bleeding disorders eg:leukemia, hemophilia...
 At the time of epidemic of polio.
 Uncontrolled systemic diseases.
 During the period of menses.

8. ROSE’S POSITION FOR
TONSILLECTOMY

9. TECHNIQUES OF
TONSILLECTOMY
COLD METHODS
HOT METHODS

10. COLD METHODS
Dissection and snare(most common)
Guillotine method.
Intracapsular tonsillectomy with debrider.
Harmonic scalpel(ultrasound)
Plasma mediated ablation technique.
Cryosurgical technique.

11. HOT METHODS
Electrocautery.
Laser tonsillectomy or tonsillotomy.
Coblation tonsillectomy.
Radio frequency.

12. STEPS OF OPERATION
(DISSECTION AND SNARE METHOD)
 Boyle-Davis mouth gag is introduced and opened.It is
held in place by Draffins bipods or a string over a
pulley.

13.  Tonsil is grasped with tonsil holding forceps and pulled
medially.
 Incision is made in the mucous membrane where it reflects
from the tonsil to anterior pillar.
 A blunt curved scissors may be used to dissect the tonsil
from the peritonsillar tissue and seperate its upper pole.
 The tonsil is held in the upper pole and traction applied
downwards and medially.Dissection is continued until lower
pole is reached.
 Wire loop of tosillar snare is threaded over the tonsil on to
its pedicle, tightened and the pedicle cut and tonsil
removed.
 A guaze is placed in the fossa and pressure applied for few
mnts.
 Bleeding points are tied with silk.Procedure is repeated on
the other side.
STEPS CONTD:

15. POST OP CARE
IMMEDIATE GENERAL CARE
-keep the patient in coma postion untill fully recovered
from anasthesia.
- keep a watch on bleeding from nose and mouth.
-keep check on vitals ie pulse,BP,and RR.

16. Diet
-after fully recovered; cold milk or icecream.
-sucking of ice cubes gives relief from pain.
-gradually from soft to solid food.
-plenty of fluids should be encouraged.

17. Oral hygeine
-Pt is given Condy’s or hot water gargles 3-4 times a
day.
-Mouth wash with plain water after every feed.
Analgesics
-Pain, locally in the throat and reffered to ear can be
relieved by analgesics like paracetamol.
Antibiotics
-A suitable antibiotic can be given orally or by injection
for a week.

18. COMPLICATIONS
IMMEDIATE DELAYED
•Primary h’ge
•Reactionary h’ge
•Injury to tonsillar pillars,uvula,soft
palate,tongue orsuperior costrictor
muscle.
•Injury to teeth
•Aspiration of blood.
•Facial oedema.
•Secondary h’ge
•Infection
•Lung complications
•Scarring in soft palate and pillars.
•Tonsillar remnants.
•Hypertrophy of lingual tonsil.

19. THANK YOU