Tonsillitis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Chronic cases may indicate tonsillectomy (surgical removal of tonsils) as a choice for treatment.[1] Subacute tonsillitis (which can last between 3 weeks and 3 months) is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is almost always bacterial.
Surgery
Indications for Tonsillectomy
Following are the indications for tonsillectomy:[2]
- Recurrent tonsillitis
- Chronic tonsillitis
- Recurrent acute pharyngitis
- Obstructive sleep apnea due to hyperplasia of adenoids and tonsils
- Failure to thrive
- Hemorrhagic tonsillitis
- Suspicion for malignancy
The paradise criteria for tonsillectomy is[1]
- 3 episodes every year for more than 3 years or
- 5 episodes every year for 2 years or
- 7 episodes in a year
Pre-operative Medical Prophylaxis
- Antibiotics are given before tonsillectomy to decrease the risk of infections after the surgery.[3]
- Ampicillin/sulbactam or Clindamycin or amoxicillin-clavulanate or cefazolin can be used for this purpose[4][5]
Tonsillectomy
- The surgery associated with the removal of the tonsils is termed a tonsillectomy.
- Tonsillectomies are performed primarily on children that suffer from recurrent, acute bacterial tonsillitis.
- All other cases should consider first line therapy.
- The criteria for a child to undergo a tonsillectomy consists of seven or more documented and treated episodes in the previous year.
- Other criteria may be met if five or more episodes occur in the two preceding years.
- Hemorrhaging is a common, postoperative concern.
- The least amount of hemorrhaging is associated with a cold dissection.
- Risk of postoperative hemorrhaging can be further lessened with the proper usage of sutures and ligatures.
- Procedures involving lasers, mono or bipolar forceps, and coblation have displayed a higher risk of postoperative hemorrhaging. [6]
- Currently, partial removal remains the surgical option of choice.
Post Opperative Complications
The post operative complications may include:
- Fever
- Atelectasis
- Pneumonia
- Urinary tract infection
- Deep vein thrombosis
- Jaundice
- Sepsis
- Hyponatremia
References
- ↑ 1.0 1.1 Paradise JL, Bluestone CD, Bachman RZ; et al. (1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. PMID 6700642. - Paradise studied 187 children with tonsillectomy or tonsillectomy and adenoidectomy. 91 children were randomly put in surgical and non-surgical groups. The other 96 were place by parent’s choice. The results favored the surgical group on reoccurrence of throat infections during their initial and second year follow-up where the data was collected. While non-surgical groups did better in the long run. 13 out of the 95 surgical group encountered surgical complications after their second year follow up
- ↑ Darrow DH, Siemens C (2002). "Indications for tonsillectomy and adenoidectomy". Laryngoscope. 112 (8 Pt 2 Suppl 100): 6–10. doi:10.1002/lary.5541121404. PMID 12172229.
- ↑ Weber RS (1997). "Wound infection in head and neck surgery: implications for perioperative antibiotic treatment". Ear Nose Throat J. 76 (11): 790–1, 795–8. PMID 9397626.
- ↑ Johnson JT, Kachman K, Wagner RL, Myers EN (1997). "Comparison of ampicillin/sulbactam versus clindamycin in the prevention of infection in patients undergoing head and neck surgery". Head Neck. 19 (5): 367–71. PMID 9243262.
- ↑ Skitarelić N, Morović M, Manestar D (2007). "Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery". J Craniomaxillofac Surg. 35 (1): 15–20. doi:10.1016/j.jcms.2006.10.006. PMID 17296307.
- ↑ Tonsillitis and sore throat in children. United States National Library of Medicine. National Institutes of Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273168/