Nabilah Ayob 060 100 814 Group H4 Tonsillectomy. What? Tonsillectomy is defined as the surgical...
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- Slide 1
- Nabilah Ayob 060 100 814 Group H4 Tonsillectomy
- Slide 2
- What? Tonsillectomy is defined as the surgical excision of the
palatine tonsils. Indications : Absolute Relative
- Slide 3
- Absolute Indications Recurrent infection of throat : 7 > ep.
In 1 year or 5 ep. / year for 2 years or 3 ep. / year for 3 years
or 2 weeks > of lost school or work in 1 year Peritonsillar
abscess : In child - Done after 4-6 weeks after abscess has been
treated In adult - 2 nd attack Tonsillitis causing Febrile seizures
Hypertrophy of tonsils causing : Airway obstruction Difficulty in
deglutition Interference with speech Suspicion of malignancy In
unilaterally enlarge tonsil suspect lymphoma in children and
epidermoid carcinoma in adults.
- Slide 4
- Relative Indications Diphtheria carriers, who do not respond
with antibiotics Streptococcal tonsillitis with bad taste or
halitosis which is unresponsive to medical treatment Recurrent
streptococcal tonsillitis in a patient with valvular heart
disease.
- Slide 5
- The American Academy of Otolaryngology Head and Neck Surgery
(AAO-HNS) Paraphrased, these clinical indicators are as follows:
Absolute indications Enlarged tonsils that cause upper airway
obstruction, severe dysphagia, sleep disorders, or cardiopulmonary
complications Peritonsillar abscess that is unresponsive to medical
management and drainage documented by surgeon, unless surgery is
performed during acute stage Tonsillitis resulting in febrile
convulsions Tonsils requiring biopsy to define tissue pathology
Relative indications Three or more tonsil infections per year
despite adequate medical therapy Persistent foul taste or breath
due to chronic tonsillitis that is not responsive to medical
therapy Chronic or recurrent tonsillitis in a streptococcal carrier
not responding to beta-lactamase- resistant antibiotics Unilateral
tonsil hypertrophy that is presumed to be neoplastic
- Slide 6
- Contraindication Anemia (Hb 10g%) Acute infections Bleeding
diathesis; leukaemia, purpura, aplastic aneamia, hemophilia Overt
or submucous cleft palate Children < 3 years of age Uncontrolled
systemic disease Tonsillectomy is avoided during the period of
menses
- Slide 7
- Gradation of Tonsillar Enlargement
- Slide 8
- AnaesthesiaPosition Usually done under General anaesthesia with
endotracheal intubation. In adults it may be done under local
anasthesia Roses position : Patient lies supine with head extended
by placing a pillow under the shoulders. A rubber ring is place
under the head to stabilize it. Hyperextension should always be
avoided
- Slide 9
- Techniques of tonsillectomy Cold MethodsHot Methods Dissection
and snare Guillotine method Intracapsular tonsillectomy with
debrider Harmonic scalpel Plasma-mediated ablation technique
Cryosugical technique Electrocautery Laser tonsillectomy Coblation
tonsillectomy Radiofrequency
- Slide 10
- Surgery utensils
- Slide 11
- Steps of Operation (Dissection and Snare Method) 1. Boyle Davis
mouth gag is introduce and opened.It is held in place by Draffins
bipods or a string over a pulleys.
- Slide 12
- 2. Tonsil is grasped with forceps and pulled medially. Incision
made in the mucous membrane. 3. A blunt curved scissors may be used
to dissect the tonsil from the peritonsillar tissue and separate
its upper pole. 4. Tonsil is held at its upper pole and traction
applied downwards and medially or scissors until lower pole is
reach.
- Slide 13
- 5. Wire loop of tonsillar snare is threaded over the tonsil on
to its pedicle, tightened. 6. Pedicle is cut and the tonsil removed
7. A gauze sponge is place in the fossa and pressure applied for a
few minutes 8. Bleeding points are tied with silk. Procedure is
repeated on the other side
- Slide 14
- Post operative Care Immediate general care Keep patient in coma
position until fully recovered from anaesthesia Keep watch on
bleeding from the nose and mouth Keep check the vital signs (HR,RR
and BP) Diet After fully recover ; cold milk or ice cream Sucking
of ice cube gives relief from pain Gradually from soft to solid
food. Plenty of fluids should be encourage
- Slide 15
- Oral Hygiene Pt. is given Condys or Salt water gargles 3-4
times a day Mouth wash with plain water after every feed Analgesics
Warn patients that pain will abate during the first 3-5 days then
increase for 1-2 days before completely disappearing Paracetamol
can be taken to relieve pain Antibiotics A suitable antibiotics can
be given orally or by injection for a week.
- Slide 16
- Complications ImmediateDelayed Primary heamorrhage Reactionary
haemorrhage Injury to tonsillar pillars, uvula, soft palate, tounge
or superior constrictor muscle Injury to teeth Aspiration of blood
Facial oedema Secondary haemorrhage Infection Lung complications
Scarring in soft palate and pillars Tonsillar remnants Hypertrophy
of liangual tonsil