What is a Tonsillectomy?

Chronic tonsillitis can not only cause infection of adjacent organs due to its own inflammation, such as otitis media, sinusitis, larynx, trachea, bronchitis, etc., but more importantly, it is one of the common infections in the human body, and is associated with acute nephritis and rheumatoid arthritis. , Rheumatic fever, heart disease, chronic low fever and other diseases are closely related. Therefore, in addition to anti-infective treatment in the recurrence of tonsillitis, surgery should be performed when necessary. Surgical treatment should also be considered when diseases such as excessive tonsil enlargement or tumor occur.

Basic Information

English name

tonsillectomy

Visiting department

ENT

Multiple groups

Patients with excessive tonsil enlargement or tumors

Common locations

tonsil

Indications for tonsillectomy

1. Chronic tonsillitis with repeated acute attacks or multiple attacks of peritonsillar abscess.

2. Excessive hypertrophy of the tonsils, obstruction of swallowing, respiratory function and language ambiguity.

3. Chronic tonsillitis causes lesions such as rheumatic fever, nephritis, arthritis, and rheumatic heart disease, or is associated with adjacent tissue and organ lesions.

4. Those who have tonsil keratosis or diphtheria carrier, who have failed conservative treatment.

5. A variety of benign tumors of the tonsil, for malignant tumors should be carefully selected cases.

Contraindications for tonsillectomy

1. In the case of acute tonsillitis, surgery is generally not performed, and surgery can be performed 3-4 weeks after the inflammation subsides.

2. Hematopathy, hypertension, compensatory insufficiency of heart disease, active tuberculosis, etc. are not suitable for surgery.

3. Symptoms such as rheumatic fever and nephritis should not be operated when uncontrolled.

4. Poliomyelitis and influenza, women's menstrual period is temporarily not suitable for surgery.

5. The family members of patients have high incidence of immunoglobulin deficiency or autoimmune diseases. Those with a white blood cell count below 3000.

Preparing for tonsillectomy

1. Carefully inquire about the medical history and physical examination, paying special attention to the inquiry about the history of bleeding and the examination of the bleeding coagulation mechanism.

2. Blood, urine, stool routine and coagulation time examination.

3. Chest X-ray and ECG examination. General anesthesia, liver and kidney function tests.

4. General anesthesia is fasted before surgery, and local anesthesia is used, and a small amount of diet or fasting is appropriate before surgery. Atropine was injected subcutaneously half an hour before the operation. (Extrusion method is not required). Patients who are nervous can take sedatives.

Tonsillectomy surgery method

There are two types of surgery: peeling and squeezing. Stripping can usually be performed under local or general anesthesia. After anesthesia, the tonsils were pulled with tonsil forceps, and the free margin of the genioglossus arch and the part of the velopharyngeal arch were cut with a machete. The tonsil capsule was separated with a tonsil exfoliator, and the tonsils were freed from top to bottom. Finally, the lower root tonsils, tonsils and complete resection of the tonsils were removed with a trap. In recent years, the use of low-temperature plasma-assisted tonsillectomy can reduce surgical bleeding and shorten the time. The squeezing method is to use a special tonsil squeezing knife to insert it from the lower level. Turn the knife ring to put the back of the tonsil and the upper level. The thumb of the other hand is used to press all the tonsils into the ring. After tightening the handle, quickly twist the tonsil. Remove by pulling.

Postoperative management of tonsillectomy

1. The patients were in the lateral position. Patients with local anesthesia are advised to discharge the secretions from the mouth along the corner of the mouth and do not swallow them to observe whether there is bleeding. Patients under general anesthesia should pay attention to swallowing before waking up, and if so, check for bleeding.

2. The liquid food can be taken four hours after the operation. On this day, the white film can grow to a liquid food. When the wound is painful, apply a cold compress on the neck.

3. On the second day after surgery, a white film appeared on the wound surface, which is a normal reaction. The white membrane began to fall off about 5 to 7 days after the operation, and the wound surface formed granulation, and the surface epithelium began to grow. If the white film is dirty gray, you should pay attention to the possibility of infection. You can use antibiotics and gargle with 0.5-1% hydrogen peroxide solution.

Complications of tonsillectomy

Bleeding

Bleeding within 24 hours after surgery is primary bleeding, which is more common and occurs within 6 hours after surgery. It may be due to incomplete surgery, residual debris or inadequate hemostasis, or the vasoconstrictive effect of epinephrine in anesthetic. Causes of vasodilation after disappearance; it may also be a small bleeding point that has already been bleeding, caused by pharynx movement, cough or temporary increase in blood pressure, etc., caused by lack of vitamin C, reduced thrombin levels, and sudden changes in weather. Promote postoperative bleeding. Secondary bleeding often occurs 5 to 6 days after the operation, mainly when the white film begins to fall off, and bleeding occurs due to a hard swallowing abrasion, which can be prevented if you pay attention to it. If it is secondary infectious bleeding, it should be strengthened, such as anti-infection.

Wound infection

Patients with low resistance, inadequate aseptic operation during surgery or postoperative bleeding can be associated with wound infection. The wound surface does not grow white film, or the white film is dirty and incomplete, and the throat is congested, swollen, sore throat, and sometimes accompanied by fever. Use plenty of antibiotics and 0.5 to 1% hydrogen peroxide to gargle.

3. Complications

In addition, lung abscesses, bronchial pneumonia, atelectasis, deep neck abscesses or cellulitis, and foreign bodies in the respiratory tract can be complicated.