Don’t overlook the complications of tonsillectomy
These pre- and postop steps can help you make an already safe procedure even safer.
TABLE 3
Tonsillectomy techniques
| Technique | Instrumentation | Method |
|---|---|---|
| “Cold steel” | Scalpel, dissector, guillotine | Complete blunt dissection of the tonsil from its capsule, while preserving its pillars |
| “Hot” | Diathermy, BiClamp forceps | Complete electrodissection of the tonsil from its capsule, while preserving its pillars |
| Powered intracapsular | Microdebrider | Near-complete removal of the tonsil (90%-95%) |
| Harmonic scalpel | Harmonic scalpel | Use of ultrasound energy to remove the tonsil |
| Coblation | Bipolar device | Use of radiofrequency energy to remove the tonsil in a cooler temperature |
| Laser | CO2, KTP lasers | Evaporization of tonsillar tissue |
| Source: Shah UK, Terk A. New techniques for tonsillectomy and adenoidectomy. Oper Tech Otolaryngol. 2009;20:160-166. | ||
Complications when an adenoidectomy is also done
There is an increased risk of complications when an adenoidectomy and tonsillectomy are performed together, simply because there is another operative site. The complications that may occur after adenoidectomy include velopharyngeal insufficiency and nasopharyngeal stenosis. Primary care physicians should watch for nasal or oral bleeding, crusting, halitosis, and velopharyngeal insufficiency. An ear, nose, and throat consultation is warranted when in doubt.
CORRESPONDENCE Yehudah Roth, MD, Department of Otolaryngology, Head & Neck Surgery, The Edith Wolfson Medical Center, P.O. Box 5, 58100 Holon, Israel; orl@wolfson.health.gov.il
