Tonsillectomy Indications, Contraindications, Procedure, Complications

A tonsillectomy is a surgery to remove the tonsils. The Tonsils are two oval shaped pads of tissues that are present at the back of throat. It is a procedure done to remove the tonsils when the diseases of tonsils like Tonsillitis is not responding to medications and is creating problems in daily life of the patient like The patient might be suffering from breathing difficulties or swallowing problems. 

Tonsillectomy Indications:

The absolute indications are:

• Recurrent infection of the throat  is considered when the infection persists,
  • >/= 7 episodes in 1 year or
  • 5 episodes per year for 2 consecutive years or
  • 3 episodes per year for 3 consecutive years
• In children with Peritonsillar abscess, it is done for 4-6 weeks after the abscess has been treated.
• Tonsillitis with Febrile Seizures.
• Hypertrophy of the tonsil causing :
  • Airway obstruction during sleep ( Obstructive Sleep Apnea Malignancy)
  • Difficulty in deglutition
  • Interference with speech
  • If there is suspicion in malignancy then it is very important to remove the tissue. Because a unilaterally enlarged tonsil can be a Lymphoma in children. Therefore an excisional biopsy should be done.

The relative indications are:

• Diphtheria carriers ( no response to antibiotics)
• Streptococcal carriers ( source of infection to others)
• Chronic tonsillitis with bad taste or halitosis ( unresponsive to medical treatment)
• Recurrent streptococcal tonsillitis with valvular heart disease.
• Tonsillectomy can be done as a part of another surgery. The another surgeries that requires the tonsillectomy are Palatopharyngoplasty ( in sleep apnea syndrome) and Glossopharyngeal neurectomy.

Tonsillectomy Contraindications

• Hemoglobin<10g%
• Acute infection in upper respiratory tract, Acute tonsillitis because it will lead to more bleeding.
• In Children <3 years of age , there is increased risk related to surgeries.
• Submucous cleft palate.
• If the patient has any hemostatic disorder then the surgery should be avoided as there is a great risk of having a hemorrhage. The diseases are Von-willebrand disease, Bleeding dosrders like leukemia, purpura etc.
• During menstruation.

Also Read: Important Ent Surgeries : Adenoidectomy, Tonsillectomy, Septoplasty

Tonsillectomy Procedure

The steps are:

1. A boyle-Daris mouth gag with a tongue blade is used.
2. A slot is used for the endotracheal tube.
3. The upper jaw is retracted by the upper end of the blade and the lower jaw is retracted by the tongue blade.
4. An oropharyngeal pack is placed to prevent aspiration.
5. The tonsil is held with the help of a tonsil holding forceps, it is pulled medially to create the traction
6. An incision is made near the anterior pillar of the tonsil to find the dissection plane( space between the capsule and the superior constrictor muscle).
7. The coblator aids in the cutting and coagulating of the tissue
8. Start dissecting from the lateral aspect and then from the superior pole.
9. Continue dissecting until the lower pole of the tonsil has been made into a podicle.
10. Then, use snare to crush and cut-off the base of the tonsil from its bed.
11. Locate the bleeding points with the help of a retractor and then coagulate the bleeding points.

Tonsillectomy Complications

Tonsillectomy requires a major hemostatic care because there is a risk of excessive bleeding from the tonsillar bed. Immediate complications are:

• Primary Hemorrhage: It occurs at the time of operation. It can be controlled by pressure, ligation or electrocoagulation.
• Reactionary Hemorrhage: It occurs within 24 hours post-surgery and Is controlled by simple measures such as removal of clots and application of pressure or vasoconstrictor.
• Secondary Hemorrhage: It occurs due to infection and seen after 24 hours upto 14 days post surgery. It is managed conservatively by applying pressure packs in the tonsillar fossa.
• There is a risk of aspiration of blood.
• Facial edema
• Surgical emphysema.
• Delayed Complications are Infection and Scarring in soft palate.

Also Read: Pediatric Neck Masses Types and Causes, Symptoms, Diagnosis and Treatment

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