Tonsillectomy

Mevuni Mahanama
191303071
DEFINITION
 INDICATIONS
ABSOLUTE
• Recurrent infections of throat.
• Seven or more episodes in 1 year
• Peritonsillar abscess.
• In kids - 4 to 6 weeks after abscess is
treated
• In adults - 2nd attack
• Tonsillitis.
• Hypertrophy of tonsils. It causes:
• (a) airway obstruction (sleep apnoea),
• (b) difficulty in deglutition and
• (c) interference with speech.
• Suspicion of malignancy.
RELATIVE
• Diphtheria carriers, who do not respond to
antibiotics.
• Streptococcal carriers, who may be the
source of infection to others.
• Chronic tonsillitis with bad taste which is
unresponsive to medical treatment.
• Recurrent streptococcal tonsillitis in a patient
with valvular heart disease.
CONTRAINDICATIONS

• Hemoglobin level less than 10 g%.

• Presence of acute infection in upper respiratory tract/ acute tonsillitis: Increase risk of bleeding
• Children under 3 years of age.
• Overt or submucous cleft palate.
• Bleeding disorders, e.g. leukemia, purpura, aplastic anemia or hemophilia.
• At the time of epidemic of polio.
• Uncontrolled systemic disease, e.g. diabetes, cardiac disease, hypertension or asthma.
• Period of menses
TECHNIQUES
PROCEDURE
1. Anesthesia: General anesthesia with endotracheal intubation
2. Position:
• Rose’s position, i.e. patient lies supine with head extended by placing a pillow under
the shoulders.
• A rubber ring is placed under the head to stabilize it
PROCEDURE
• Boyle–Davis mouth gag is introduced and opened and held in place by Draffin’s bipods or a string
over a pulley.
• 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
PROCEDURE
• A blunt curved scissor may be used to dissect the tonsil from the peritonsillar tissue and separate
its upper pole.
• 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
• Now wire loop of tonsillar snare is threaded over the tonsil on to its pedicle, tightened, and the
pedicle cut and the tonsil removed
• Gauze sponge is placed in the fossa and pressure applied for a few minutes.
• Bleeding points are tied with silk
POST- OP CARE
POST- OP CARE
COMPLICATIONS - IMMEDIATE
1. Primary hemorrhage:
• Occurs at the time of operation. It can be controlled by pressure, ligation or electrocoagulation
of the bleeding vessels
2. Reactionary hemorrhage.
• Occurs within a period of 24 h and can be controlled by simple measures such as removal of
the clot, application of pressure or vasoconstrictor.
3. Injury to tonsillar pillars, uvula, soft palate, tongue.
4. Injury to teeth.
5. Aspiration of blood.
6. Facial oedema.
7. Surgical emphysema.
COMPLICATIONS –DELAYED
1. Secondary hemorrhage:
• Usually seen between the fifth to tenth postoperative day
2. Infection:
• Infection of tonsillar fossa may lead to parapharyngeal abscess or otitis media.
3. Lung complications:
• Aspiration of blood, mucus or tissue fragments may cause atelectasis or lung abscess.
4. Scarring in soft palate and pillars.
5. Tonsillar remnants:
• Tonsil tags or tissue, left due to inadequate surgery, may get repeatedly infected.
6. Hypertrophy of lingual tonsil – Late complication
THANK YOU!