Overview

Tonsillectomy is a surgical procedure to remove the tonsils, commonly performed for recurrent tonsillitis, sleep apnea, or other tonsillar conditions.

Tonsillectomy is crucial for treating recurrent infections, obstructive sleep apnea, and improving quality of life in affected patients.

Learn more in our comprehensive RxDx ENT Course

Indications

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Recurrent Tonsillitis

Multiple episodes per year

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Sleep Apnea

Obstructive sleep apnea

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Tonsillar Abscess

Peritonsillar abscess

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Tonsillar Hypertrophy

Airway obstruction

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Chronic Tonsillitis

Persistent infection

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncontrolled bleeding
✗ Severe coagulopathy

Relative Contraindications

✗ Active infection
✗ Recent surgery
✗ Cardiac disease

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, anesthesia planning, equipment setup, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, administer anesthesia.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate anesthesia

💡 Pro Tip:

Use proper positioning.

Step 2: Mouth Gag Placement

Insert mouth gag for exposure.

⚠️ Common Mistakes to Avoid:

  • Poor exposure
  • Tongue injury

💡 Pro Tip:

Protect tongue and teeth.

Step 3: Tonsil Dissection

Dissect tonsil from bed.

⚠️ Common Mistakes to Avoid:

  • Incomplete removal
  • Bleeding

💡 Pro Tip:

Use proper technique.

Step 4: Hemostasis

Control bleeding from tonsillar bed.

⚠️ Common Mistakes to Avoid:

  • Inadequate hemostasis
  • Post-op bleeding

💡 Pro Tip:

Ensure complete hemostasis.

Step 5: Bilateral Procedure

Repeat for opposite tonsil.

⚠️ Common Mistakes to Avoid:

  • Asymmetric removal
  • Incomplete procedure

💡 Pro Tip:

Ensure symmetry.

Step 6: Post-procedure Care

Monitor and provide instructions.

⚠️ Common Mistakes to Avoid:

  • Poor monitoring
  • Inadequate instructions

💡 Pro Tip:

Provide clear instructions.

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Post-procedure Care

Post-procedure care involves pain management, hydration, monitoring for bleeding, and dietary restrictions.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 2-5% Active bleeding, hematemesis Return to OR, cautery Proper hemostasis
Infection 1-3% Fever, pain, foul odor Antibiotics Sterile technique
Dehydration 5-10% Poor intake, lethargy IV fluids Encourage hydration
Velopharyngeal insufficiency 1-2% Nasal regurgitation Speech therapy Proper technique

Clinical Pearls

💡

Use proper mouth gag positioning.

🎯

Ensure complete hemostasis.

⚡

Monitor for post-op bleeding.

🔍

Check for residual tonsillar tissue.

📊

Document procedure details.

🎨

Provide clear post-op instructions.

⚠️

Be prepared for emergency management.