Tonsillectomy in adults: Operative procedures
- Jose W Ruiz, MD
Jose W Ruiz, MD
- Assistant Professor
- University of Miami
Tonsillectomy is a well-established operative procedure. Most patients have an uncomplicated course, but bleeding and pain can be significant perioperative issues.
The tonsils consist of lymphoid tissue covered by respiratory epithelium. "Tonsils" refers specifically to the palatine tonsils, and "adenoids" refers to the pharyngeal tonsils. In addition, there are lingual tonsils on the posterior tongue and tubal tonsils just posterior to the Eustachian tube opening. Waldeyer's ring is the ring of these four lymphoid tissues in the pharynx formed by the palatine tonsils ("tonsils"), pharyngeal tonsils ("adenoids"), tubal tonsils, and lingual tonsils (figure 1A-B).
The tonsils are positioned laterally in the pharyngeal wall between the palatoglossal arch and palatopharyngeal arch (the anterior and posterior tonsillar pillars) which merge superiorly to become the soft palate (figure 2). Each tonsil is contained within its own fascia. A potential space between the tonsil and the pharyngeal constrictor muscle can accumulate pus and become a peritonsillar abscess. The tonsil is innervated by branches from the glossopharyngeal nerve. Lymphatic drainage includes the upper jugular and jugulo-diagastric lymph nodes.
The tonsillar vascular supply is from branches of the external carotid artery (figure 3).
●Superior pole: Descending palatine artery
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- PATIENT SELECTION
- PREOPERATIVE EVALUATION
- Medical risk assessment
- Medication review
- Anatomic risk assessment
- PROPHYLACTIC ANTIBIOTICS
- OPERATIVE MANAGEMENT
- Measures to prevent complications
- - Instrumentation
- - Technique
- POSTOPERATIVE MANAGEMENT
- Postoperative antibiotics
- Pain management
- Nausea and vomiting
- Minor bleeding
- - Patient education
- - Return to work
- Major bleeding
- - Primary and secondary hemorrhage
- - Control of life-threatening hemorrhage
- Pulmonary complications
- Postoperative tonsillar bed infection
- Other complaints and complications
- SUMMARY AND RECOMMENDATIONS