Tonsillectomy – 24 Previous Year NEET PG Question for Practice

TONSILLECTOMY

INDICATION AND CONTRAINDICATION OF TONSILLECTOMY

INDICATION

  • Recurrent throat infections
  • Peritonsillar abcess
  • Tonsillitis causing febrile seizures
  • Rheumatic tonsillitis
  • Hypertrophy of tonsils causing sleep apnoea or speech interference
  • Any suspicion of malignancy

CONTRAINDICATION

  • Performing tonsillectomy during poliomyelitis epidemic is an absolute contraindication.
    • Unimmunised children may develop polio following tonsillectomy.
    • A tonsillectomy may be performed long after the epidemic has passed and the child is immunised against polio.
  • Surgery should be postponed if there is evidence of acute infection or suspicion of a clotting dysfunction .
    • It is much safer to wait some 3 weeks and put patient on antibiotics after an acute inflammatory before operating, because of the greatly increased risk of postoperative haemorrhage.

COMPLICATIONS OF TONSILLECTOMY

i)  Immediate

ii) Delayed

Immediate complications:

1) Primary haemorrhage Occurs at the time of operation.

Torrential bleed during tonsillectomy is due to Paratonsillar vein

It can be controlled by pressure, ligation or electrocoagulation of the bleeding vessels.

2) Reactionary haemorrhage : Occurs within a period of 24 hours.

Reactionary haemorrhage mostly occurs due to dislodgement of any clot or because BP of patient comes back to normal after hypotensive anaesthesia.

It is treated by a return to the theater when the vessel is ligated under anesthesia.

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 oedemaSome patients get oedema of the face particularly of the eyelids.

7) Surgical emphysema

Delayed complications:

  1. Secondary haemorrhageUsually seen between the 5th to 10th post-operative day. It is the result of sepsis and premature separation of the membrane. Usually, it is heralded by bloodstained sputum but may be profuse.
  2. InfectionInfection of tonsillar fossa may lead to parapharyngeal abscess or otitis media.
  3. Lung complicationsAspiration of blood, mucus or tissue fragments may cause atelectasis or lung abscess.
  4. Scarring in soft palate and pillars.
  5. Tonsillar remnantsTonsil tags or tissue, left due to inadequate surgery, may get repeatedly infected.
  6. Hypertrophy of lingual tonsilThis is a late complication and is compensatory to loss of palatine tonsils.

NEWER METHODS OF TONSILLECTOMY

  1. The newer methods of tonsillectomy include:
  2. Coblation: utilizes a thin layer of ionized sodium to ablate tissues.       
  3. Harmonic scapel.            
  4. Ligasure (Thermal Welding).
  5. Laser .              
  6. Intra-capsular methods.

Exam Question of

  • Coblation intracapsular tonsillectomy utilizes a thin layer of ionized sodium to ablate tissues.
  • Tonsillectomy is contraindicated in Polio Epidemic.
  • Tonsillectomy is recommended if number of acute infections in a year exceed 3 years.
  • Recurrent throat infections, peritonsillar abcess, tonsillitis causing febrile seizures, hypertrophy of tonsils causing sleep apnoea or speech interference and any suspicion of malignancy are absolute indications for tonsillectomy.
  • Secondary Haemorrhage after tonsillectomy usually presents between the 5th to 10th postoperative day.
  • Surgery should be postponed if there is evidence of acute infection or suspicion of a clotting dysfunction
  • It is much safer to wait some 3 weeks  and put patient on antibiotics after an acute inflammatory before operating, because of the greatly increased risk of postoperative haemorrhage.
  • Most common postoperative complication of tonsillectomy is hemorrhage.
  • Torrential bleed during tonsillectomy is due to Paratonsillar vein.

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Tonsillectomy

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