Tonsillectomy ENT for undergrad

ent procedure
tonsillectomy for mbbs year 4

1. TONSILLECTOMY NUR FARRA NAJWA BINTI ABDUL AZIM 082015100035

2. LEARNING OBJECTIVE Indication Anaesthesia Position Steps Post operative care Other method Complication

3. INTRODUCTION A  tonsillectomy  is a surgical procedure to remove the tonsils

4. A. ABSOLUTE Recurrent infections of throat . ( a) Seven or more episodes in 1 year, or ( b) Five episodes per year for 2 years, or ( c) Three episodes per year for 3 years, or ( d) Two weeks or more of lost school or work in 1 year. 2. Peritonsillar abscess . 3. Tonsillitis. 4. Hypertrophy of tonsils. 5 . Suspicion of malignancy .

5. B. RELATIVE 1 . Diphtheria carriers. 2. Streptococcal carriers . 3. Chronic tonsillitis . 4. Recurrent streptococcal tonsillitis in a patient with valvular heart disease.

6. C. AS A PART OF ANOTHER OPERATION 1 . Palatopharyngoplasty 2. Glossopharyngeal neurectomy . 3. Removal of styloid process.

7. CONTRAINDICATION 1. Haemoglobin level less than 10 g%. 2. Presence of acute infection in upper respiratory tract , 3 . Children under 3 years of age . 4. Overt or submucous cleft palate. 5. Bleeding disorders 6 . At the time of epidemic of polio. 7. Uncontrolled systemic disease. 8. Tonsillectomy is avoided during the period of menses.

8. ANAESTHESIA General anaesthesia with endotracheal intubation. In adults (may be under local anaesthesia .)

9. POSITION Rose’s position Hyperextension should always be avoided

10. STEPS OF OPERATION (DISSECTION AND SNARE METHOD ) 1. Boyle–Davis mouth gag is introduced and opened. Held in place by Draffin’s bipods or a string over a pulley. 2 . Tonsil is grasped with tonsil-holding forceps and pulled medially . 3. Incision is made in the mucous membrane where it reflects from the tonsil to anterior pillar. It may be extended along the upper pole to mucous membrane between the tonsil and posterior pillar.

11. Cont. 4. A blunt curved scissor may be used to dissect the tonsil from the peritonsillar tissue and separate its upper pole. 5. Now the tonsil is held at its upper pole and traction applied downwards and medially. Dissection is continued with tonsillar dissector or scissors until lower pole is reached 6. Now wire loop of tonsillar snare is threaded over the tonsil on to its pedicle, tightened, and the pedicle cut and the tonsil removed .

12. Eve’s tonsil snare

13. Cont. 7. A gauze sponge is placed in the fossa and pressure applied for a few minutes. 8. Bleeding points are tied with silk. Procedure is repeated on the other side.

14. POSTOPERATIVE CARE 1. Immediate general care (a) Keep the patient in coma position until fully recovered from anaesthesia . (b) Keep a watch on bleeding from the nose and mouth. (c) Keep check on vital signs .

15. Cont. 2. Diet . 3. Oral hygiene. 4. Analgesic 5. Antibiotics

16. Other Methods For Tonsillectomy

17. IMMEDIATE COMPLICATION 1. Primary haemorrhage . 2 . Reactionary haemorrhage . 3 . Injury to tonsillar pillars, uvula, soft palate, tongue or superior constrictor muscle due to bad surgical technique . 4. Injury to teeth. 5. Aspiration of blood. 6. Facial oedema . 7 . Surgical emphysema .

18. LATE COMPLICATION 1. Secondary haemorrhage . 2 . Infection . 3. Lung complications . 4. Scarring in soft palate and pillars. 5. Tonsillar remnants. 6. Hypertrophy of lingual tonsil.

19. SUMMARY Indication Anaesthesia Position Steps Post operative care Other method Complication

20. REFERENCES Diseases of Ear, Nose, and Throat & Head and Neck Surgery, PL Dhingra , Shruti Dhingra , 6 th Edition http://www.elvirethouvenot.com/tonsillectomy/