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Nabilah Ayob 060 100 814 Group H4 Tonsillectomy

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What? Tonsillectomy is defined as the surgical excision of the palatine tonsils. Indications : Absolute Relative

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Absolute Indications Recurrent infection of throat : 7 > ep. In 1 year or 5 ep. / year for 2 years or 3 ep. / year for 3 years or 2 weeks > of lost school or work in 1 year Peritonsillar abscess : In child - Done after 4-6 weeks after abscess has been treated In adult - 2 nd attack Tonsillitis causing Febrile seizures Hypertrophy of tonsils causing : Airway obstruction Difficulty in deglutition Interference with speech Suspicion of malignancy In unilaterally enlarge tonsil suspect lymphoma in children and epidermoid carcinoma in adults.

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Relative Indications Diphtheria carriers, who do not respond with antibiotics Streptococcal tonsillitis with bad taste or halitosis which is unresponsive to medical treatment Recurrent streptococcal tonsillitis in a patient with valvular heart disease.

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The American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Paraphrased, these clinical indicators are as follows: Absolute indications Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage Tonsillitis resulting in febrile convulsions Tonsils requiring biopsy to define tissue pathology Relative indications Three or more tonsil infections per year despite adequate medical therapy Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase- resistant antibiotics Unilateral tonsil hypertrophy that is presumed to be neoplastic

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Contraindication Anemia (Hb 10g%) Acute infections Bleeding diathesis; leukaemia, purpura, aplastic aneamia, hemophilia Overt or submucous cleft palate Children < 3 years of age Uncontrolled systemic disease Tonsillectomy is avoided during the period of menses

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Gradation of Tonsillar Enlargement

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AnaesthesiaPosition Usually done under General anaesthesia with endotracheal intubation. In adults it may be done under local anasthesia Roses position : Patient lies supine with head extended by placing a pillow under the shoulders. A rubber ring is place under the head to stabilize it. Hyperextension should always be avoided

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Techniques of tonsillectomy Cold MethodsHot Methods Dissection and snare Guillotine method Intracapsular tonsillectomy with debrider Harmonic scalpel Plasma-mediated ablation technique Cryosugical technique Electrocautery Laser tonsillectomy Coblation tonsillectomy Radiofrequency

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Surgery utensils

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Steps of Operation (Dissection and Snare Method) 1. Boyle Davis mouth gag is introduce and opened.It is held in place by Draffins bipods or a string over a pulleys.

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2. Tonsil is grasped with forceps and pulled medially. Incision made in the mucous membrane. 3. A blunt curved scissors may be used to dissect the tonsil from the peritonsillar tissue and separate its upper pole. 4. Tonsil is held at its upper pole and traction applied downwards and medially or scissors until lower pole is reach.

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5. Wire loop of tonsillar snare is threaded over the tonsil on to its pedicle, tightened. 6. Pedicle is cut and the tonsil removed 7. A gauze sponge is place in the fossa and pressure applied for a few minutes 8. Bleeding points are tied with silk. Procedure is repeated on the other side

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Post operative Care Immediate general care Keep patient in coma position until fully recovered from anaesthesia Keep watch on bleeding from the nose and mouth Keep check the vital signs (HR,RR and BP) Diet After fully recover ; cold milk or ice cream Sucking of ice cube gives relief from pain Gradually from soft to solid food. Plenty of fluids should be encourage

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Oral Hygiene Pt. is given Condys or Salt water gargles 3-4 times a day Mouth wash with plain water after every feed Analgesics Warn patients that pain will abate during the first 3-5 days then increase for 1-2 days before completely disappearing Paracetamol can be taken to relieve pain Antibiotics A suitable antibiotics can be given orally or by injection for a week.

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Complications ImmediateDelayed Primary heamorrhage Reactionary haemorrhage Injury to tonsillar pillars, uvula, soft palate, tounge or superior constrictor muscle Injury to teeth Aspiration of blood Facial oedema Secondary haemorrhage Infection Lung complications Scarring in soft palate and pillars Tonsillar remnants Hypertrophy of liangual tonsil