Tonsillectomy

Tonsillectomy-topic from dhingra

1. TONSILLECTOMY PREPARED BY: ADARSHLAL DIVAKARAN AZEEZIA MEDICAL COLLEGE KOLLAM

2. INDICATIONS OF TONSILLECTOMY DIVIDED INTO 3: 1.ABSOLUTE. 2.RELATIVE. 3.AS A PART OF ANOTHER OPERATION. WHAT IS TONSILLECTOMY? TONSILLECTOMY IS DEFINED AS THE SURGICAL EXCISION OF PALATINE TONSILS.

3. 1.ABSOLUTE Recurrent infections of the throat. Peritonsillar abscess. Tonsillitis causing febrile seizures. Hypertrophy of tonsils causing -airway obstruction -difficulty in deglutition. -interference with speech. Suspicion of malignancy:unilaterally enlarged tonsil-lymphoma in children/ epidermoid ca in adult.

4. 2.RELATIVE Diptheria carriers who do not respond to antibiotics. Streptococcal carriers, who may be source of infection to others. Chronic tonsilltis with bad taste or halitosis which is unresponsive to medicines. Recurrent strep tonsillitis in pts with valvular heart disease.

5. 3.AS A PART OF OTHER OPERATION Palatopharyngoplasty which is done for sleep apnoea syndrome. Glossopharyngeal neurectomy.Tonsil is removed first and then IX nerve is severed in the bed of tonsil. Removal of styloid process.

6. CONTRAINDICATIONS Hb level less than 10 g%. Presence of a/c infection in URI. Children under 3 yrs of age. Overt or submucous cleft palate. Bleeding disorders eg:leukemia , hemophilia ... At the time of epidemic of polio. Uncontrolled systemic diseases. During the period of menses.

7. ROSE’S POSITION FOR TONSILLECTOMY

8. TECHNIQUES OF TONSILLECTOMY COLD METHODS HOT METHODS

9. COLD METHODS Dissection and snare(most common) Guillotine method. Intracapsular tonsillectomy with debrider . Harmonic scalpel(ultrasound) Plasma mediated ablation technique. Cryosurgical technique.

10. HOT METHODS Electrocautery . Laser tonsillectomy or tonsillotomy . Coblation tonsillectomy. Radio frequency.

11. STEPS OF OPERATION (DISSECTION AND SNARE METHOD) Boyle-Davis mouth gag is introduced and opened.It is held in place by Draffins bipods or a string over a pulley.

12. Tonsil is grasped with tonsil holding forceps and pulled medially. Incision is made in the mucous membrane where it reflects from the tonsil to anterior pillar. A blunt curved scissors may be used to dissect the tonsil from the peritonsillar tissue and seperate its upper pole. The tonsil is held in the upper pole and traction applied downwards and medially.Dissection is continued until lower pole is reached. Wire loop of tosillar snare is threaded over the tonsil on to its pedicle, tightened and the pedicle cut and tonsil removed. A guaze is placed in the fossa and pressure applied for few mnts . Bleeding points are tied with silk.Procedure is repeated on the other side. STEPS CONTD:

13. POST OP CARE IMMEDIATE GENERAL CARE -keep the patient in coma postion untill fully recovered from anasthesia . - keep a watch on bleeding from nose and mouth. -keep check on vitals ie pulse,BP,and RR.

14. Diet -after fully recovered; cold milk or icecream . -sucking of ice cubes gives relief from pain. -gradually from soft to solid food. -plenty of fluids should be encouraged.

15. Oral hygeine -Pt is given Condy’s or hot water gargles 3-4 times a day. -Mouth wash with plain water after every feed. Analgesics -Pain, locally in the throat and reffered to ear can be relieved by analgesics like paracetamol . Antibiotics -A suitable antibiotic can be given orally or by injection for a week.

16. COMPLICATIONS IMMEDIATE DELAYED Primary h’ge Reactionary h’ge Injury to tonsillar pillars,uvula,soft palate,tongue orsuperior costrictor muscle. Injury to teeth Aspiration of blood. Facial oedema. Secondary h’ge Infection Lung complications Scarring in soft palate and pillars. Tonsillar remnants. Hypertrophy of lingual tonsil.

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