![]() The tonsils are surrounded by a fibrous capsule The superior pharyngeal constrictor muscle lies laterally. The palatine tonsils are found in the tonsillar fossa, limited by the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly.Relate: may feel like 'the worst sore throat of your life' until it heals.Assess for risk of VPI (velopharyngeal insufficiency) and relate the potential for nasal regurgitation of food/fluid and hypernasal speech (anatomic abnormalities such as submucous cleft is a relative contraindication).Damage to adjacent structures (lips, teeth, tongue).Bleeding, infection, reaction to the anesthesia.Discuss potential complications with patient/family.Acute infection (relative) "hot tonsillectomy" or 'tonsillectomy a chaud' is reasonable treatment for peritonsillar abscess (2008 Berry et al) and (2012 Akin et al).Poor anesthetic risk or uncontrolled medical illness.Contraindications for tonsillectomy include the following:.Misc: Asymmetric enlargement with suspicion of neoplasm Abnormal facial growth recurrent hemorrhagic tonsillitis velopharyngeal insufficiency secondary to enlarged tonsils.Infective: Recurrent tonsillitis, cryptic tonsillitis, chronic tonsillitis, peritonsillar abscess, or halitosis.Obstruction: Upper airway obstruction, Obstructive sleep apnea, poor feeding and failure to thrive, hypernasal speech secondary to enlarged tonsils.In general, we have also witnessed a shift in the indication for the procedure with a movement from an infective process to that of airway obstruction. The procedure peaked in the 1970's with approximately one million cases performed per year. GENERAL CONSIDERATIONS: Although the incidence of the tonsillectomy and adenoidectomy has decreased in recent years, it is still the most common major surgery performed in children.Tonsillectomy bleed (hemorrhage) management (post-tonsillectomy hemorrhage) See also: Peritonsillar Abscess Management Tonsils and Adenoids, Maximum allowable blood loss Return to: Pediatrics and Tonsil and Oropharynx Operative Notes Modified ![]()
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