Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea (OSA).
- Recurrent infections of throat
- ≥ 7 episodes in 1 yr
- ≥ 5 episodes/yr for 2 years
- ≥ 3 episodes/yr for 3 years
- ≥2 weeks lost school/work in 1 year
- Peritonsillar Abscess – [4-6 weeks after the abscess has been treated]
- Hypertrophy of Tonsils – [causing Airway Obstruction/ Difficulty in deglutition/ Interference in speech]
- Suspicion of Malignancy
- Diphtheria carriers
- Streptococcal carriers
- Chronic tonsilitis
- Recurrent streptococcal tonsilitis with valvular heart disease
Part of other operation
- Glossopharyngeal neurectomy
- Removal of styloid process
- Hb < 10g%
- Acute infection in URT
- Age ≤ 3 Yr
- Submucous cleft palate
- Bleeding disorders
- Uncontrolled systemic disease – Diabetes, Cardiac disease, Hypertension, Asthema
General anesthesia with endotracheal intubation.
Rose’s position [ Patient lies supine with head extended by placing a pillow under shoulders, A rubber ring is placed under the head ]
*Hyperextension of neck should be avoided.
- Boyle-Davis mouth gag with Draffin’s Bipod is used to keep the mouth open.
- Tonsil is held using Tonsil holding forceps and pulled medially
- Incision at mucous membrane between tonsil and anterior pillar.
- Blunt curved scissor to dissect tonsil from peritonsillar tissue to separate upper pole
- Tonsil is held at upper pole, pulled downward medially, dissection is continued till lower pole.
- Using the wire loop of Tonsillar snare the tonsillar pedicle is held, then the tonsil is cut and removed.
- Gauze sponge is applied at the fossa and pressure is applied for few minutes. Bleeding points are tied with silk
- Repeated to other side.
POST OPERATIVE CARE
- Immediate –
- Keep in Coma until anesthesia works.
- Keep watch on bleeding from nose/mouth
- Keep check on Vitals
- Diet – Liquid food can be taken after recovery, Ice to relieve pain, gradual build up of diet to solid food, Plenty of fluid intake.
- Oral Hygiene – Salt water gargles, Mouthwash with every feed.
- Analgesics – Paracetamol. [Aspirin/ Ibuprofen avoided due to bleeding chances]
- Primary Haemorrhage during operation. Controlled by pressure/ ligation/ electrocoagulation
- Reactionary Haemorrhage within 24h controlled by removal of clot, application of pressure/ vasoconstrictor
- Injury to tonsillar pillars, uvula, soft palate, teeth
- Aspiration of Blood
- Secondary Haemorrhage
- Various lung complications
- Scarring in soft palate and pillars
- Tonsillar remnants that may be left and gets repeatedly infected.
- Hypertrophy of lingual tonsil.
BOYLE DEVIS MOUTH GAG
DENIS BROWN FORCEPS
EVE TONSILLAR SNARE