Tonsillectomy

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Tonsillectomy is one of the most frequently performed operations in the world. Stricter indications for operating, however, are reducing the number of tonsillectomies. Recurrent episodes of acute tonsillitis, interfering with school or work, are the main indications. A quinsy or chronic tonsillitis are other indications, along with marked enlargement interfering with the airway.

Fig. 4.62 The tonsillar fossae following tonsillectomy. These are covered with a white/yellow membrane for about 10 days until the fossae are epithelialized.

Fig. 4.63 Tonsils after removal to demonstrate the lingual pole (arrow). The pole must be included at tonsillectomy. A tonsil remnant may be left inadvertently at this site, giving rise to further infection, but tonsils do not "regrow." Adenoid tissue is, however, not possible to enucleate and remove in toto; it may recur, particularly when removed before age 4.

Fig. 4.62 The tonsillar fossae following tonsillectomy. These are covered with a white/yellow membrane for about 10 days until the fossae are epithelialized.

Pain After Tonsil RemovalDay Four Picture Tonsill Remove

Fig. 4.63 Tonsils after removal to demonstrate the lingual pole (arrow). The pole must be included at tonsillectomy. A tonsil remnant may be left inadvertently at this site, giving rise to further infection, but tonsils do not "regrow." Adenoid tissue is, however, not possible to enucleate and remove in toto; it may recur, particularly when removed before age 4.

Day Four Picture Tonsill Remove

Fig. 4.64 Secondary infection. A blood clot in the tonsillarfossa is an important postoperative finding, and almost certainly indicates secondary infection. This occurs between day three and 10, and is associated with bleeding and increased pain. The bleeding is usually scanty and settles when antibiotics control the secondary infection. Severe delayed bleeding after tonsillectomy may occur, however. The finding of a blood clot in a tonsillar fossa must not be ignored.

Fig. 4.64 Secondary infection. A blood clot in the tonsillarfossa is an important postoperative finding, and almost certainly indicates secondary infection. This occurs between day three and 10, and is associated with bleeding and increased pain. The bleeding is usually scanty and settles when antibiotics control the secondary infection. Severe delayed bleeding after tonsillectomy may occur, however. The finding of a blood clot in a tonsillar fossa must not be ignored.

Blood Clot Foot Bruise

Fig. 4.65a, b Secondary tonsillar infection with bleeding and bruising of the soft palate. This appearance may be related to an excessively traumatic tonsillectomy. An infected blood clot is present in the tonsillar fossa; removal may cause more bleeding. A tonsillar blood clot present with primary bleeding, however, should be removed if possible, as this may settle the bleeding.

Fig. 4.65a, b Secondary tonsillar infection with bleeding and bruising of the soft palate. This appearance may be related to an excessively traumatic tonsillectomy. An infected blood clot is present in the tonsillar fossa; removal may cause more bleeding. A tonsillar blood clot present with primary bleeding, however, should be removed if possible, as this may settle the bleeding.

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Fig. 4.66 Guillotine tonsillectomy. Tonsillectomy today is by dissection with minimal injury to the fauces and surrounding structures. Adept use of the guillotine may also be a rapid and effective surgical technique, but removal of the uvula and fauces is possible in inexperienced hands. Fortunately, postoperative scarring of the palate and uvula is frequently symptom-free. This appearance of the soft palate with conspicuous shortening is similar to that following the uvulopalatoplasty operation for severe snoring (see Fig. 4.38a, b).

Fig. 4.67 Palatal trauma.

Laceration to the hard and soft palate are not uncommon. The oft-given advice to children not to "run with a pencil or similar object in their mouth" is intended to offset palatal laceration resulting from a fall. Suturing, however, is usually unnecessary, and unless there is gross mucosal separation, the palate and tongue heal well spontaneously following trauma.

Fig. 4.66 Guillotine tonsillectomy. Tonsillectomy today is by dissection with minimal injury to the fauces and surrounding structures. Adept use of the guillotine may also be a rapid and effective surgical technique, but removal of the uvula and fauces is possible in inexperienced hands. Fortunately, postoperative scarring of the palate and uvula is frequently symptom-free. This appearance of the soft palate with conspicuous shortening is similar to that following the uvulopalatoplasty operation for severe snoring (see Fig. 4.38a, b).

Sores UvulaEpiglottis Normal

Fig. 4.68 Epiglottitis. This is a serious, life-threatening condition and a diagnosis that may be missed. The complaint of a sore throat in an ill patient with a history of dysphagia and fever, often strongly suggestive of a quinsy, is associated with little amiss on oral examination. Such a situation strongly suggests epiglottitis, and a lateral soft-tissue radiograph is frequently diagnostic. This is a diagnosis not to be missed, and awareness that it also occurs in children is important.

The normal narrow contour of the epiglottis is seen to be replaced by a round swelling (b: arrow). This condition, if ignored, may lead to stridor, respiratory obstruction, and death if the airway is occluded.

Early diagnosis, hospital admission, and intravenous antibiotic therapy (e.g., cefuroxime) is curative. Close nursing observation of the airway is necessary.

Fig. 4.68 Epiglottitis. This is a serious, life-threatening condition and a diagnosis that may be missed. The complaint of a sore throat in an ill patient with a history of dysphagia and fever, often strongly suggestive of a quinsy, is associated with little amiss on oral examination. Such a situation strongly suggests epiglottitis, and a lateral soft-tissue radiograph is frequently diagnostic. This is a diagnosis not to be missed, and awareness that it also occurs in children is important.

The normal narrow contour of the epiglottis is seen to be replaced by a round swelling (b: arrow). This condition, if ignored, may lead to stridor, respiratory obstruction, and death if the airway is occluded.

Early diagnosis, hospital admission, and intravenous antibiotic therapy (e.g., cefuroxime) is curative. Close nursing observation of the airway is necessary.

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  • nahand
    Can you lose hearing after tonsil removal?
    1 year ago

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