Management of Tonsillitis - Steps of tonsillectomy

Medical and surgical management of tonsillitis - steps of tonsillectomy explained in a detailed way

1. Management of tonsillitis Venkatesh Karthikeyan III MBBS Velammal Medical College Email : [email protected]

2. Management Medical Surgical

3. Medical management Usually in acute tonsillitis Treated with: Paracetamol (analgesia) Gargles of glycerol – thymol (soothing) Penicillin V Ampicillin is avoided

4. Surgical Management Indications Contraindications Anaesthesia Position Steps of operation Post – op care

5. Indications Absolute Relative As a part of another operation

6. Absolute Indications Recurrent throat infection (7-5-3-14) Peritonsillar abscess Tonsillitis Hypertrophy of tonsils Suspicion of Malignancy

7. Relative indication Diphtheria carriers Streptococcal carriers Recurrent streptococcal tonsillitis in patients with valvular heart disease Chronic tonsillitis with halitosis

8. As a part of another operation Palatopharyngoplasty (in sleep apnoea) Removal of styloid process (elongated – recurrent cervicofacial pain – Eagle’s syndrome) Glossopharyngeal neurectomy (for cancer related carotid sinus syncope)

9. Contraindications Hb < 10g% Presence of acute infection in upper respiratory tract (bleeding) Age <3 Cleft palate Bleeding disorders Polio epidemic Co-morbidity Menstruation

10. Position for tonsillectomy

11. Steps of operation

12. Dissection and Snare Method Boyle – Davis mouth gag is introduced and opened It is held in place by Draffin’s bipods

13. Boyle Davis mouth gag

14. Draffin’s bipod

15. Grasp the tonsil with the tonsil holding forceps

16. Pull the tonsil medially

17. Incise at the mucous membrane where it reflects from tonsil to anterior pillar

18. Wire loop of tonsillar snare is threaded over the tonsil on its pedicle T ightened Pedicle cut Tonsil removed

19. Tonsillar snare

20. Place the gauze sponge in the fossa Apply pressure for few minutes Tie bleeding points with silk/cauterize Repeat the procedure on other side

21. Dissection and Snare Method Boyle – Davis mouth gag – Draffin’s bipods Tonsil holding forceps – pull medially Incision Thread a wire loop of tonsillar snare over tonsillar pedicle and cut it Remove the tonsil Gauze sponge – pressure – bleeding control Repeat on the other side

22. Post operative care Immediate general care Diet Oral hygiene Analgesics Antibiotics

23. Immediate general care Recovery from anaesthesia Keep a watch on bleeding Monitor vitals

24. Diet Liquid diet Soft to solid foods on second day

25. Oral hygiene Salt water gargles 3-4 times a day Mouth wash with plain water after every feed

26. Analgesics and antibiotics Paracetamol 30 minutes before meal Avoid aspirin and ibuprofen (Increases bleeding) Choose appropriate antibiotics

27. Other techniques of tonsillectomy Cold method Hot method

28. Cold Method Guillotine method Intracapsular tonsillectomy with debrider Harmonic scalpel Plasma mediated ablation technique Cryosurgical technique

29. Hot method Electrocautery Laser tonsillectomy Coblation tonsillectomy Radiofrequency

30. References: Diseases of Ear, Nose and Throat – PL Dhingra , 6 th edition Short practice of surgery – Bailey & Love – 26 th edition www.ncbi.nlm.nih.gov

31. Thank you 