Tonsillectomy or Surgery of Tonsils require Immediate post operative general care, In this keep check on vital signs, that is, pulse, respiration and blood pressure keep the patient in coma position until he became fully recovered from anesthesia, keep checking for any bleeding from nose and mouth. Oral hygiene, patient is given salt water gargles 3-4 times. a day. A mouth wash with plain water after every feed keep the mouth clean. Take care of diet.
When patient is fully recovered he is permitted to take liquid, e.g. cold milk or ice cream sucking of ice cubes gives relief form pain. Diet is gradually built from soft to solid food, they may use custard jelly, soft boiled eggs or slice of bread soaked in milk on the 2nd day. Plenty of fluids should be taken. Analgesics. Pain, locally the throat which may refer to ear, can be relieved by analgesics like paracetamol, Antibiotics, A suitable antibiotics can be given orally or by injection for a week.
When do start working
Patient is usually sent home 24 hours after operation unless there is some complication. Patient can resume his normal duties within two weeks.
Contraindications: The contraindication of this operation is Anemia, Children under 3 year of age because they are at poor surgical risk, In uncontrolled systemic diseases like diabetes, hypertension or asthma, Cleft palate, Presence of acute infection in the upper respiratory tract, even acute tonsiitis, Bleeding Disorders like purpura, leukemia, aplastic anemia, hemophillia, At Epidemics of polio, also avoided during period of menses.
Complications in Surgery of Tonsils
Post tonsillectomy hemorrhage is the most important and may be a fatal complication. It is divided into three types:
Occurs on the operation table the removal of the tonsils injury to paratonsillar vein is a common cause of this type of haemorrhage. lt can controlled by pressure, legation or elctrocoagulation of the bleeding vessel.
It occurs within 24 hour after the operation. lt occurs either because of slipping of the ligature or by elevation of blood pressure when the hypotensive effect of general anesthesia is over. Slipping of the ligature occurs due to loose and violent efforts like cough and vomiting may predispose its slippage. lt may occur either immediately after surgery in the recovery room or may occur in the ward. In mild cases, patient may be managed conservatively or it is controlled by simple measures like removal; of clot, application of pressure and vasoconstriction. In severe cases it is treated by taking the patient back to the operation theatre and the bleeder is legated under general anesthesia.
Secondary Hemorrhage may occur after12 hour till 14 days, when the healing in tonsillar fossa is completed. Usually it occurs on 5th post operative day. The cause is infection of tonsillar bed with sloughing of small vessels in its bed. The hemorrhage associated with fever. It is treated by antibiotics, rest, sedation, and observation in hospital. In severe cases when hemorrhage is unresponsive to treatment then under general anesthesia fossa is packed and pillars stretched together and pack is removed after few days.
Aspiration of blood: Aspiration of blood may occur in unconscious patient when cough reflex is suppressed due to action of general anesthesia. This is prevented by placing patient under lateral position.
Tonsillar tisuue may left after surgery due to inadequate removal, later it became hypertrophied lead to sore throat. Injury to oral cavity and pharynx: Damage to structure of mouth and pharynx may occur. Structure in the tonsillar bed may be injured. Dislocation of temporomandibular joint may occur due to forceful opening of mouth.
Palatal injury: Soft palate may be damaged lead to its fibrosis, shortening and scarring.
Other Complications in Surgery of Tonsils
These are cerebral hypoxia, cardiac arrest and lung collapse.
facial edema may occur and puffiness of eyelids.
Rarely occur when there is injury to superior constrictor muscle. Referred earache: It may occur after tonsillectomy
Hypertrophied Lingual Tonsil:
Compensatory increase in size of lingual tonsil occur. It is late complication. Smoking cessation hypnotherapy at http://northlondonhypnotherapist.co.uk/