Tonsillectomy

Definition

• The surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side.

• Prophylactic procedure to prevent future episodes of infection

Anatomy and Surgical procedure

Anatomy and Surgical procedure

Anatomy and Surgical procedure

Anatomy and Surgical procedure

Anatomy and Surgical procedure

Anatomy and Surgical procedure

• Pre-op– History• Bleeding DO• Anesthesia tolerance• OSA• Down (C1-C2 subluxation)

Anatomy and Surgical procedure

Anatomy and Surgical procedure

• Post-op– Pain control (liquid acetaminophen)– Adequate diet (soft foods more easily swallowed)– Hydration– Abtibiotics– Avoid smoking, lifting heavy things and exertion.

Anatomy and Surgical procedure

• Follow-up– Patient at 5-8 days– 4-6 wks. after surgery

Indications and Contraindications

Complications and Prognosis

• Bleeding• Pain• Hypernasal speech• Rare: nasopharyngeal stenosis• Death from massive hemorrhage and

anesthetic complcitions

Cochrane Review

• More severely affected children adeno-/tonsillectomy will avoid three unpredictable episodes of any type of sore throat, including one episode of moderate or severe sore throat in the next year.

• Less severely affected children may never have had another severe sore throat anyway and the chance of them so doing is modestly reduced by adeno-/tonsillectomy.

• A prerequisite for constructive debate about uncertainties about the effects of treatments is a greater willingness among professionals and the public to admit and discuss them, combined with the humility to acknolwedge that good intentions alone have not protected patients from the unintended harmful effects of treatments.

- Iain Chalmers

• Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001802. DOI: 10.1002/14651858.CD001802.pub2

• Burton MJ, Rosenfeld RM. Evidence-based tonsillectomy. Otolaryngology - Head and Neck Surgery 2009: 141 (3, Supplement 1): 17

• “Tonsillectomy – Tonsils & Adenoid Surgery Complications” retrieved from http://www.entusa.com/tonsillectomy_complications.htm on October 6, 2010.

• http://basicpathology-histopathology.blogspot.com/2009/11/pharynx-anatomy-and-physiology.html

• http://www.plymouthent.com/tonsillitis_adenoidectomy.html