Tonsillectomy and Adenoidectomy
From Holoprosencephaly
TONSILLECTOMY AND ADENOIDECTOMY
The tonsils are masses of lymphoid tissue encircling the pharyngeal cavity. The palatine tonsils are located on each side of the oropharynx, visible on oral examination. The pharyngeal tonsils, also known as the adenoids are located in the posterior wall of the nasopharynx.
Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. The filtering function of the tonsils is believed to protect the respiratory and digestive tracts from pathogenic invasion.
The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems.
Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids.
Intervention
The surgery is performed under general anesthesia. This means your child will be unconscious and pain-free.
The ear-nose-throat (ENT) surgeon inserts a small instrument into the mouth to prop it open.
The tonsils are then cut or burned away. The adenoid tissue can be removed with an instrument such as a curette or a microdebrider. Some surgeons may opt to cauterize the adenoids instead of removing the tissue. Bleeding is controlled with packing and cauterization. The cuts usually heal naturally without stitches.
The patient will remain in the recovery room after surgery until he is awake and able to breathe easily, cough, and swallow. Most patients are allowed to go home several hours later.
Post-op
Coughing or clearing the throat frequently is discouraged because it irritates the operative site. Suction should be readily available.
The throat is very sore after surgery. Analgesics are usually ordered but may need to be given rectally, through g-tube or parenterally to avoid the oral route. If the child is very irritable or crying excessively, mild sedation may be needed to prevent injury to operative site.
Food and fluid are restricted until child is fully alert and there are no signs of hemorrhage.
Cool water, ice pops or diluted fruit juice may be given first.
Post-op hemorrhage is not usual but can occur. There should be careful monitoring for excessive swallowing or bright red blood seeping out of the mouth or in the oral cavity. Notify the physician immediately if this occurs.
After Discharge
Monitor for signs of airway obstruction and bleeding Highly seasoned or irritating foods should be avoided. Most children are able to eat and drink normal amount and consistencies of food 8-12 hours post-op Avoid the use of vigorous toothbrushing or gargling Minimal coughing or clearing throat. Suction should be available at home. Appropriate form of analgesics should be available for administration
Mouth odor and mild ear pain may persist for a few days. Most children may resume normal activity in 5 -7 days.
Prognosis
After tonsillectomy, the number of throat infections is usually reduced, but not completely eliminated. Most children have less trouble breathing through the nose and fewer and milder sore throats and ear infections after adenoidectomy. In rare cases, adenoid tissue that has been removed may grow back, but this usually does not cause a problem.
Sources: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm http://www.nlm.nih.gov/medlineplus/ency/article/003011.htm
If you have any concerns, please don't hesitate to discuss your concerns with your child's doctor(s).
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