Tonsillectomy Prof. Dr. Medni Mahmoud Otolaryngealology Ain Shams University
Indications • 1- Frequent attacks of acute tonsillitis ( more than 3 attacks/year for at least 2 years). • 2- One attack of Quinsy. • 3- Chronic tonsillitis. • 4- Chronic marked hypertrophy of tonsils interfering with respiration. • 5- When acts as septic focus. • 6- Diphtheria carrier. • 7- Cervical adenitis ( non specific). • 8- T.B. cervical adenitis. • 9- Impacted F.B. • 10- Benign tumour or for excision biopsy. • 11- Recurrent otitis media, sinusitis, arthritis. • 12- As a part of other surgeries: a) part of UVPP. b) Resection of styloid process.
Contraindications • 1- Absolute ( rare): A- Hemorrhagic blood diseases e.g : hemophilia. B- Vital organs failure. C- Short or cleft palate. D- Malignancy or when it’s a part of systemic affection. • 2- Relative : A- Acute tonsillitis: after 2-3 weeks. B- Acute URTI : commenst cause to postpone surgery. C- Active Rheumatic fever. D- Poliomyelitis epidemics. E- D.M. or HTN.
Preoperative preparations • 1- History : to exclude contraindications. • 2- General examination: to evaluate condition of the patient and anesthesia. • 3- Investigations: A) Blood : CBC, ESR, Hb%, PT and bleeding and clotting time. B) Urine analysis. C) CXR. D) ECG.
Preparations few days before surgery • 1- Penicillin for at least 4 days for any cardiac patient e.g. M.S. • 2- Patients with history of Rheumatic fever: a- All signs of activity should disappear. b- Stop salicylates 2 weeks before. c- Double dose of cortisone if patient on it. • 3- fasting 6 hours before surgery. • At morning of operation: 1- measure temp. 2- ask about menses. 3- immediately before surgery give atropine to decrease saliva in pharynx. ( not in cardiac patient).
Postoperative care • Immediate: 1- Position. 2- Advantages of position: a- allows early detection of bleeding. b- any vomitus not inhaled. c- avoid falling back of tongue and obstruction of airway. d- allow observation of lips and cyanosis. • Late ( 7-10 days): 1- Antibiotics for 7-10 days. 2- Pain killer 3- Diet: A- fasting 2-3 hours after operation. B- first 24 hours give cold soft diet and fluids. C- second day : Semi-solid at normal temp. D- third day : normal diet and avoid hard spicy foods. E- avoid constipations. F- Rest for 7 days.
Complications • 1- complication of anesthesia. • 2- Hemorrhage: commenst A- Primary. B- Reactionary . C- Secondary. • 3- Injury of nearby structures. • 4- Infection. • 5- Incomplete removal. • 6- Inhalation. • 7- Pulmonary complications.: A- respiratory obstruction. B- aspiration pneumonia. C- lung abscess.