(2) Bleeding -
Approximately one in fifty children return to the operating room for
bleeding. The incidence may be higher in adults and may approach one in
twenty patients depending upon the surgical technique used.
There is usually not to much bleeding during the operation,
but there is always a chance of bleeding after your child comes home
after the operation. Granell, et.al, (
) reported that 2.9% of children had to return to the operating room for
control of bleeding and Windfuhr, et. al., (2005) also reported a 1.5%
postoperative bleeding rate using a "COLD" technique. However in this
study, the bleeding occurred in the first 24 hours in 76% of tonsillectomy
In my practice, patients rarely bleed within the first 24 hours.
The most common time for a child to bleed after tonsillectomy or adenoidectomy
is between 4 to 8 days after surgery.
A few children will bleed on the first day after surgery, usually within the
first 2 hours. Nicklaus, et. al., reported a post-tonsillectomy
bleeding rate in the first 24 hours of 1.4% and all of these bleeds occurred
within 75 minutes after surgery.
For this reason, your child will be watched for at least 2 hours
Abstract . However, bleeding
can occur at any time, until everything is healed, which takes about two to
three weeks. Most children do not have significant bleeding afterwards,
but every year a few do. If this occurs, have the child swallow some
ice water. If the bleeding persists, you should bring your child to the
Emergency Room for evaluation. Sometimes, the child may have to return to
the operating room to control the bleeding.
Over the past decade, using the technique shown in the "Tonsillectomy and
Adenoidectomy Video" I have a postoperative bleeding rate of under 2%. The
technique is a combination of a COLD and HOT technique with removal of the
tonsils with a
scalpel and snare
and control of bleeding with electrocautery on a low setting.
I have performed coblation tonsillectomy on over
300 patients. The rate of bleeding for return to the operating room or
requiring cautery was over 4%.
3) Pain - Having adenoids removed requires 2-3 days of
recovery with some pain or discomfort. After tonsils are removed, it
hurts! It usually takes a week to 10 days for full recovery. A
shorter period of time may occur with the use of
coblation. Pain medicine and
diet instructions are given on the day of surgery. Another technique
commonly used to remove tonsils is "Sharp Dissection" with the use of
electrocautery to control bleeding. This technique has been shown in
multiple studies to create less pain than excising the tonsils using an
electrocautery or "bovie", with little difference in the postoperative bleeding
(back part of the roof of the mouth) to close off the
(back part of the nose). This may normally occur during the first four
weeks after surgery but prolonged cases may require speech therapy.
If the speech is very poor, corrective surgery may be needed. This
complication usually happens in children who have abnormalities in their
and occurs in about 1 in 3000 surgeries. It is extremely
rare to occur from a tonsillectomy alone.
4) Hypernasal speech may rarely occur after an adenoidectomy.
This type of speech results from the failure of the
5) Rarely, a small through and through hole may develop in one of
the folds in the back of the throat. This will not cause any problems and
does not require treatment.
6) Other very rare complications include: Nasopharyngeal stenosis
(the back part of the nose scars shut) from an adenoidectomy and tonsillectomy
and damage and dislocation of the cervical spine.
7) Death: This is a very rare but devastating complication.
The factors which can cause death is massive hemorrhage and anesthetic
complications such as reaction to the anesthestic or inhaling stomach contents.
The incidence of death after tonsillectomy is one in every 15,000 patients. An
ENT surgeon will perform 5 to 10 thousand tonsillectomy patients in his carrier
giving him about a 50-50 chance of having one of his patients die from the
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