A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.

1. TONSILLECTOMY
NUR FARRA NAJWA BINTI ABDUL AZIM
082015100035

2. LEARNING OBJECTIVE
• Indication
• Anaesthesia
• Position
• Steps
• Post operative care
• Other method
• Complication

3. INTRODUCTION
• A tonsillectomy is a surgical procedure to
remove the tonsils

5. INDICATION
Absolute Relative
As part of
other surgery

6. A. ABSOLUTE
1. Recurrent infections of throat.
(a) Seven or more episodes in 1 year, or
(b) Five episodes per year for 2 years, or
(c) Three episodes per year for 3 years, or
(d) Two weeks or more of lost school or work in
1 year.
2. Peritonsillar abscess.
3. Tonsillitis.
4. Hypertrophy of tonsils.
5. Suspicion of malignancy.

7. B. RELATIVE
1. Diphtheria carriers.
2. Streptococcal carriers.
3. Chronic tonsillitis.
4. Recurrent streptococcal tonsillitis in a patient
with valvular heart disease.

8. C. AS A PART OF ANOTHER OPERATION
1. Palatopharyngoplasty
2. Glossopharyngeal neurectomy.
3. Removal of styloid process.

9. CONTRAINDICATION
1. Haemoglobin level less than 10 g%.
2. Presence of acute infection in upper respiratory
tract,
3. Children under 3 years of age.
4. Overt or submucous cleft palate.
5. Bleeding disorders
6. At the time of epidemic of polio.
7. Uncontrolled systemic disease.
8. Tonsillectomy is avoided during the period of
menses.

10. ANAESTHESIA
• General anaesthesia with endotracheal
intubation.
• In adults (may be under local anaesthesia.)

11. POSITION
• Rose’s position
• Hyperextension should always be avoided

13. STEPS OF OPERATION (DISSECTION AND
SNARE METHOD)
1. Boyle–Davis mouth gag is introduced and opened. Held
in place by Draffin’s bipods or a string over a pulley.
2. Tonsil is grasped with tonsil-holding forceps and pulled
medially.
3. Incision is made in the mucous membrane where it
reflects from the tonsil to anterior pillar. It may be
extended along the upper pole to mucous membrane
between the tonsil and posterior pillar.

15. Cont.
4. A blunt curved scissor may be used to dissect the tonsil
from the peritonsillar tissue and separate its upper pole.
5. Now the tonsil is held at its upper pole and traction
applied downwards and medially. Dissection is continued
with tonsillar dissector or scissors until lower pole is
reached
6. Now wire loop of tonsillar snare is threaded over the tonsil
on to its pedicle, tightened, and the pedicle cut and
the tonsil removed.

16. Eve’s tonsil snare

17. Cont.
7. A gauze sponge is placed in the fossa and
pressure applied for a few minutes.
8. Bleeding points are tied with silk. Procedure is
repeated on the other side.

27. POSTOPERATIVE CARE
1. Immediate general care
(a) Keep the patient in coma position until fully
recovered from anaesthesia.
(b) Keep a watch on bleeding from the nose and
mouth.
(c) Keep check on vital signs.

28. Cont.
2. Diet.
3. Oral hygiene.
4. Analgesic
5. Antibiotics

29. Other Methods For Tonsillectomy

30. COMPLICATION
Immediate Delayed

31. IMMEDIATE COMPLICATION
1. Primary haemorrhage.
2. Reactionary haemorrhage.
3. Injury to tonsillar pillars, uvula, soft palate,
tongue or superior constrictor muscle due to
bad surgical technique.
4. Injury to teeth.
5. Aspiration of blood.
6. Facial oedema.
7. Surgical emphysema.

32. LATE COMPLICATION
1. Secondary haemorrhage.
2. Infection.
3. Lung complications.
4. Scarring in soft palate and pillars.
5. Tonsillar remnants.
6. Hypertrophy of lingual tonsil.

33. SUMMARY
• Indication
• Anaesthesia
• Position
• Steps
• Post operative care
• Other method
• Complication

34. REFERENCES
• Diseases of Ear, Nose, and Throat & Head and
Neck Surgery, PL Dhingra, Shruti Dhingra, 6th
Edition
• http://www.elvirethouvenot.com/tonsillecto
my/