Tonsillectomy

 Tonsillectomy is defined as the surgical excision of the

palatine tonsils.

 Indications :
 Absolute
 Relative
 Absolute Indications
 Recurrent infection of
throat :
 6 > 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 - 2nd 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.
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.
 The American Academy of Otolaryngology–
Head and Neck Surgery (AAO-HNS)
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
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
Gradation of Tonsillar Enlargement
Surgery utensils
Steps of Operation (Dissection and
Snare Method)
1. Boyle Davis mouth gag is introduce and opened.It is
held in place by Draffin’s bipods or a string over a
pulleys.
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.
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
Complications
Immediate Delayed
 Primary heamorrhage  Secondary
 Reactionary haemorrhage haemorrhage
 Injury to tonsillar  Infection
pillars, uvula, soft  Lung complications
palate, tounge or superior  Scarring in soft palate
constrictor muscle and pillars
 Injury to teeth  Tonsillar remnants
 Aspiration of blood  Hypertrophy of liangual
 Facial oedema tonsil