Don’t overlook the complications of tonsillectomy

,; ,; ,; ,

Applied Evidence

Don’t overlook the complications of tonsillectomy

J Fam Pract. 2010 October;59(10):E4-E9

PDF Download

References

1. Vestergaard H, Wohlfahrt J, Westergaard T, et al. Incidence of tonsillectomy in Denmark, 1980 to 2001. Pediatr Infect Dis J. 2007;26:1117-1121.

2. Har-El G, Nash M. Tonsillectomy and adenoidectomy. In: Krespi Y, Ossoff R, eds. Complications in Head and Neck Surgery. Philadelphia, Pa: Saunders; 1991:75–98.

3. Cohen D, Dor M. Morbidity and mortality of post-tonsillectomy bleeding: analysis of cases. J Laryngol Otol. 2008;122:88-92.

4. Brigger MT, Brietzke SE. Outpatient tonsillectomy in children: a systematic review. Otolaryngol Head Neck Surg. 2006;135:1-7.

5. Mallampati S, Gatt S, Gugino L, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429-434.

6. Vinik R, Wanner N, Pendleton RC. Periprocedural antithrombotic management: a review of the literature and practical approach for the hospitalist physician. J Hosp Med. 2009;4:551-559.

7. Asaf T, Reuveni H, Yermiahu T, et al. The need for routine pre-operative coagulation screening tests (prothrombin time PT/ partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol. 2001;61:217-222.

8. Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol. 2000;119:143-154.

9. Kotiniemi LH, Ryhänen PT, Valanne J, et al. Post-operative symptoms at home following day-case surgery in children: a multicenter survey of 551 children. Anaesthesia. 1997;52:963-969.

10. Sutters KA, Miaskowski C, Holdridge-Zeuner D, et al. A randomized clinical trial of the effectiveness of a scheduled oral analgesic dosing regimen for the management of postoperative pain in children following tonsillectomy. Pain. 2004;110:49-55.

11. Anderson BJ, Holford NH, Woollard GA, et al. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology. 1999;90:411-421.

12. Marret E, Flahault A, Samama CM, et al. Effects of post-operative, nonsteroidal, anti-inflammatory drugs on bleeding risk after tonsillectomy: meta-analysis of randomized controlled trials. Anesthesiology. 2003;98:1497-1502.

13. Cardwell M, Siviter G, Smith A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in pediatric tonsillectomy. Cochrane Database Syst Rev. 2005;(2):CD003591.-

14. Bean-Lijewski JD, Kruitbosch SH, Lewis Hutchinson L, et al. Post-tonsillectomy pain management in children: Can we do better? Otolaryngol Head Neck Surg. 2007;137:545-551.

15. Windfuhr JP, Schloendorff G, Baburi D, et al. Life-threatening post-tonsillectomy hemorrhage. Laryngoscope. 2008;118:1389-1394.

16. Alexander RJ, Kukreja R, Ford GR. Secondary post-tonsillectomy hemorrhage and informed consent. J Laryngol Otol. 2004;118:937-940.

17. Carmody D, Vamadevan T, Cooper S. Post-tonsillectomy hemorrhage. J Laryngol Otol. 1982;96:635-638.

18. Practice guidelines for blood transfusions. American Red Cross, 2007, second edition. Available at: http://www.sld.cu/galerias/pdf/sitios/anestesiologia/practical_guidelines_blood_transfusion.pdf.

19. Sonne JE, Kim SB, Frank DK. Cervical necrotizing fasciitis as a complication of tonsillectomy. Otolaryngol Head Neck Surg. 2001;25:670-672.

20. Vos GD, Marres EH, Heineman E, et al. Tension pneumomediastinum as an early complication after adenotonsillectomy. J Laryngol Otol. 1995;109:440-441.

21. Shi ZP, Wang CC, Lee JC, et al. Post-tonsillectomy hematoma of the mouth floor. Eur Arch Otorhinolaryngol. 2006;263:1041-1043.

22. Feinberg A, Shabino C. Acute pulmonary edema complicating tonsillectomy and adenoidectomy. Pediatrics. 1985;75:112-114.

23. Liechti M, Feurer R, Gross D, et al. Prevention of post-operative nausea and vomiting in children following adenotonsillectomy, using tropisetron with or without low-dose dexamethasone. J Anesth. 2007;21:311-316.

24. Thomsen J, Gower V. Adjuvant therapies in children undergoing adenotonsillectomy. Laryngoscope. 2002;112:32-34.

25. Burkart CM, Steward DL. Antibiotics for reduction of post-tonsillectomy morbidity: a meta-analysis. Laryngoscope. 2005;115:997-1002.

26. Clement DM, Supriya WA, McKerrow WS. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev. 2008;(2):CD005607.-

27. Tami T, Burkus J, Strom C. Cervical osteomyelitis: an unusual complication of tonsillectomy. Arch Otolaryngol Head Neck Surg. 1987;112:992-994.

28. Colclasure J, Graham S. Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. Ear Nose Throat J. 1990;69:155-160.

29. Agut Fuster MA, del Campo Biosca J, Ferrer Rodríguez A, et al. Post-tonsillectomy hyponatremia: a possible lethal complication. Acta Otorrinolaringol Esp. 2006;57:247-250.

30. McRae RG, Weissburg AJ, Chang KW. Iatrogenic hyponatremia: a cause of death following pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol. 1994;30:227-232.

31. Goins MR, Pitovski DZ. Post-tonsillectomy taste disorder: a significant complication. Laryngoscope. 2004;114:1206-1213.

32. Gupta S, Sing S, Misra T, et al. Fracture of the mandibular condyle as a complication of tonsillectomy. Ear Nose Throat J. 1989;68:477-479.

33. Song D, Maher CO. Spinal disorders associated with skeletal dysplasias and syndromes. Neurosurg Clin N Am. 2007;18:499-514.

34. Wilson BC, Jarvis BL, Haydon III RC. Nontraumatic subluxation of the atlantoaxial joint: Grisel’s syndrome. Ann Otol Rhinol Laryngol. 1987;96:705-708.

TABLE 3
Tonsillectomy techniques

Technique	Instrumentation	Method
“Cold steel”	Scalpel, dissector, guillotine	Complete blunt dissection of the tonsil from its capsule, while preserving its pillars
“Hot”	Diathermy, BiClamp forceps	Complete electrodissection of the tonsil from its capsule, while preserving its pillars
Powered intracapsular	Microdebrider	Near-complete removal of the tonsil (90%-95%)
Harmonic scalpel	Harmonic scalpel	Use of ultrasound energy to remove the tonsil
Coblation	Bipolar device	Use of radiofrequency energy to remove the tonsil in a cooler temperature
Laser	CO₂, KTP lasers	Evaporization of tonsillar tissue
Source: Shah UK, Terk A. New techniques for tonsillectomy and adenoidectomy. Oper Tech Otolaryngol. 2009;20:160-166.

Complications when an adenoidectomy is also done
There is an increased risk of complications when an adenoidectomy and tonsillectomy are performed together, simply because there is another operative site. The complications that may occur after adenoidectomy include velopharyngeal insufficiency and nasopharyngeal stenosis. Primary care physicians should watch for nasal or oral bleeding, crusting, halitosis, and velopharyngeal insufficiency. An ear, nose, and throat consultation is warranted when in doubt.

CORRESPONDENCE Yehudah Roth, MD, Department of Otolaryngology, Head & Neck Surgery, The Edith Wolfson Medical Center, P.O. Box 5, 58100 Holon, Israel; orl@wolfson.health.gov.il