Tonsillectomy & Adenoidectomy (tonsil and
surgery) is the most common major surgery performed in children.
This section contains several graphic videos of tonsillectomy and
adenoidectomy which should only be
viewed by adults. To the left,
the top button links to a multimedia presentation (requires Media Player
9) on tonsillectomy and adenoidectomy.
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Alert - Health care
professionals should prescribe an alternate
analgesic for post-operative pain control in children who
are undergoing tonsillectomy and/or adenoidectomy. Codeine
should not be used for pain in children following these
children have evidence of being ultra-rapid metabolizers of
codeine, which is an inherited (genetic) ability that causes
the liver to convert codeine into life-threatening or fatal
amounts of morphine in the body.
tonsillectomy is performed to treat recurrent infections, especially if it is
associated with a "
Throat," which keeps coming back several times a year
after antibiotic treatment. If medicine cannot treat or prevent the
infections and the infections come back often, a tonsillectomy may be
indicated. Several studies have shown that a tonsillectomy is an effective
treatment for children with frequently recurring tonsillitis (chronic
Click on colored text for word
The most common reason for tonsillectomy and adenoidectomy is is to remove
enlarged tonsils and adenoids which block a child's breathing passages.
The nose may be so blocked by the adenoid (which is located behind the nose and
above the back of the throat--see the below pictures) that a child can't smell,
has a congested nose, and talks like he has a cold all the time. If the
tonsils are to large, a child may not eat well, taking only small, soft foods.
The child may also have some choking and mouth breathing. Often, a child snores
very loudly, may not breathe well while asleep, and may actually stop breathing
for several seconds. If severe and not treated, this can put strain on the
heart and lungs. It has been shown that removal of the tonsils and
adenoids is effective in treating obstructive
picture on the far right shows an enlarged adenoid blocking the nasal passage.
The picture on the near right shows 4+ kissing tonsils blocking the oral airway.
Both children needed to have these tissues removed to establish an adequate
without other indications (i.e.,abnormal appearance, symptoms or history) is
often a benign finding and usually does not require treatment..
not all airway obstruction in children is caused by
adenoids or tonsils. Here is a case of an 8 year old child with
who had very small tonsils and adenoids but nasal airway obstruction due to a
spur and swollen
picture to the right shows an enlarged adenoid seen at the time of
surgery. Mouse-over the picture to label the adenoid, click on
picture to enlarge.
Graphic Videos - These Videos May Not Be Suited For All Viewers !!ewers !!
Abscess (Quinsy Tonsillectomy): A tonsillectomy may also be performed to acutely
treat a peritonsillar abscess. The picture to the right shows the
physical findings of a peritonsillar abscess in a 5 year old child.
Note the distention of the right peritonsillar pillar (blue arrows) and
the deviation of the uvula to the left (red arrow). The child also
had a "hot potato" voice and mild difficulty swallowing.
A peritonsillar abscess is often confused with severe exudative
tonsillitis. In exudative tonsillitis, it is the tonsils
which are enlarged and not the anterior tonsillar pillar. Often,
needle aspiration is needed to make the diagnosis.
Most peritonsillar abscesses can be treated by incisional or needle
drainage. However, in the young child this is usually not possible
and a trip to the OR is necessary. Often there will also be a
history of chronic tonsillitis. In this case, removing the tonsils
is the preferred treatment.
Graphic Video - This Video May Not Be Suited For All Viewers !!
Adenotonsillectomy is major surgery. Children used to stay overnight
but in the USA this surgery is commonly performed on an outpatient basis.
Surgery usually lasts from 30 minutes to an hour, but sometimes takes longer.
During this time, you can wait in the preoperative waiting room or other part of
There are many different surgical techniques for removing the tonsils.
Tonsils have been removed using a
knife, electrocautery, laser,
coblation tonsillectomy. All of these
techniques have their advantages and disadvantages. Some such as the laser
was very popular in the 1980's but fell out of favor after it was shown to have
delayed healing and increased the time the patient is under general anesthesia.
The microdebrider is slow and does not control bleeding giving it little
advantage over using a scalpel.
Tomkinson et al. Cold dissection
tonsillectomy has a lower rate of delayed bleeding than dissection with
bipolar diathermy or coblation.
What is most important is the experience of your surgeon. This is one
surgery you do not want to go to the lowest bidder. Find an
experienced surgeon who is skilled with a particular technique and has good
outcomes. Do not worry so much about the exact technique used.
The video on the right shows
The use of the ENTcepts to remove
tonsils and control bleeding.
The oldest and most time tested
techniques are HOT and COLD tonsillectomy. In HOT dissection the
tonsils are removed with an electrocautery. In COLD dissection, a surgical
knifeis used to remove the tonsils. Both techniques have comparable
post-operative bleeding rates but COLD dissection has been shown to produce less
However, Lee, et.al, found that the
HOT dissection had a significantly higher secondary bleeding rate
View Abstractand has more post-operative pain than COLD dissection. Ferreira et.
al found less intra-operative bleeding but more pain with a hot technique.
Graphic Videos - These Videos May Not
Be Suited For All Viewers !!
Techniques Which Control Bleeding During the Operation and Reduce Pain.Coblation
tonsillectomy and adenoidectomy was introduced in 2001. In this
technique, a wand is used to coagulate and ablate tissue using a cool
electrical current at the tip of the wand. It produces cooler
tissue temperatures and less adjacent tissue destruction than in a HOT
tonsillectomy. Timms (2002) reported
produces less pain than a HOT tonsillectomy
View Abstract. Bleeding rates have
been reported to be similar to non-coblation tonsillectomy ( Divi and
Benninger 2005 )
View Abstract . Belloso, et.al.(2003) reported that
tonsillectomy had a lower rate of secondary hemorrhage than non-coblation
tonsillectomy in both children and adults.
Lowe D, Van der Meulen J
in the Lancet (2004) reported that the risk of hemorrhage was greater
for HOT (diathermy
) tonsillectomies and
than for COLD techniques
using knife dissection and suture ligatures to control bleeding.
et al. also reported an increase in post-operative bleeding using
coblation. View Abstract
Graphic Video - This Video May Not Be Suited For All Viewers!!s!!
scalpel is very useful in young
patients, especially those at risk of rapid dehydration due to poor oral
intake secondary to postoperative pain. The
controls bleeding from small vessels and several
studies have reported that patients experience less postoperative pain. View
The cost of the procedure is increased and in older patients more brisk
bleeding may be encountered which may require the use of electrocautery.
Cauterization will increase postoperative pain and tends to negate the
advantage of using the
However, in this case the ability of the
to reduce the bleeding aids in the performance of the surgery.
Scotch, et.al., has reported that complication rates are comparable to (in
this study actually less than) other techniques.
Search PubMed for Harmonic Scalpel Tonsillectomy
In a recent article by Mehta et. al.
Three techniques for removing tonsils were compared (electrocautery,
harmonic scalpel and coblation). The authors found that pain after
the operation was similar using the harmonic scalpel and electrocautery
but was significantly less using coblation. It also appeared that
patients undergoing coblation tonsillectomy returned more quickly to a
Graphic Video - This Video
May Not Be Suited For All Viewers !!
Graphic Video - This Video
May Not Be Suited For All Viewers !!
(Note: You may have noticed that I have quoted one article
that says HOT and COLD techniques have the same post- operative bleeding rates
and another which states that a HOT tonsillectomy has more bleeding than a COLD
tonsillectomy. Such discrepancies are commonly found in the medical
literature and are thought to be due to the differences in skill between
surgeons using the various technique. Thus, if a surgeon has performed
6,000 operations in technique "A" this technique may have better results for him
than technique "B" even though technique "B" may produce better results for the
average surgeon. The most important thing you
need to do is to find an experienced surgeon
who is skilled with a particular technique and has good outcomes. Don't worry so
much about the exact technique used.)
After surgery, your child will be in the recovery room for about an hour.
He or she will then be brought to the room to see you and spend some time slowly
-- Bleeding occurs in 1 to 4% of patients
who undergo a tonsillectomy. -- Poor speech (hypernasal speech) occurs in 1/3000 patients. A higher
rate occurs in patients with mental retardation or cranio-facial
deformities. -- Nasopharyngeal Stenosis: This is scaring and occlusion of the
back part of the nose. This is a rare complication which can occur
after the tonsils and adenoids are removed. -- Chipped teeth: This may be caused by slippage of the mouth-gag
retractor. -- Electocautery burns -- Death
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