Tonsillitis surgery

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:

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/

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[pmid6700642-1] 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

[pmid12172229-2] 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.

[pmid9397626-3] 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.

[pmid9243262-4] 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.

[pmid17296307-5] 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.

[NLM-6] 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/

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