Tonsillectomy

Tonsilectomy is a common and basic procedure in the otolaryngology department. It is required to completely remove the entire tonsil together with the capsule to treat recurrent chronic tonsillitis with certain effects. However, attention and cautious attitudes should be taken for tonsillectomy, otherwise complications can occur and even serious consequences can result. Treatment of diseases: tonsillitis Indication 1. The diseases of the tonsils themselves, such as repeated acute tonsillitis, peritons around the tonsils, due to the inflated upper airway caused by tonsil hyperplasia and hypertrophy in children, and even difficulty breathing and inconvenient swallowing, feasible tonsillectomy. Others such as tonsil keratosis and tonsil tumors can also be treated with this surgical method. For patients with chronic pharyngitis, tonsillectomy does not improve their symptoms. 2. Patients with adjacent organs due to chronic tonsillitis, such as recurrent episodes of acute rhinitis, pharyngitis, otitis media, cervical lymphadenitis and other tonsils, can perform tonsillectomy. 3. Chronic tonsillitis as a lesion causing other organ diseases in the body, such as rheumatic fever, rheumatic heart disease, arthritis and nephritis, can be considered for tonsillectomy. Contraindications Surgery should be carefully considered or postponed if: 1. The active period of systemic diseases, such as tuberculosis, diabetes, blood diseases, mental illness, and the epidemic of acute infectious diseases. 2. Acute tonsillitis is not suitable for surgery during the attack period. Generally, surgery can be performed 3 to 4 weeks after the attack. 3. Patients with hypertension and atherosclerosis, if the systolic blood pressure exceeds 20~21.3kpa, it is not suitable for surgery to avoid bleeding. 4. The body is weak and thin, old or suffering from serious diseases; children under the age of 5 do not advocate surgery. 5. Patients with rheumatic fever, rheumatic heart disease, arthritis and nephritis have not been stabilized, and surgery is not suitable. Women are temporarily suspended during the menstrual period, and there are more opportunities for bleeding due to surgery. Preoperative preparation Although tonsill surgery is simple, it should not be carried out rashly. The following checks should be done before surgery: 1. A detailed history of the disease, with or without bleeding, infectious diseases, rheumatism and nephritis, and physical examination. 2. Blood routine tests and clotting time should be checked. For patients with a history of rheumatism, check for anti-"o", erythrocyte sedimentation rate, mucin, etc. Patients with a history of nephritis should check their urine routine to choose surgery during a stable period. 3. Care should be taken to clean the mouth before surgery, and rinse with 1:5000 nitrofurazone solution or saline. 4. Patients with tonsils due to lesions, such as rheumatism, nephritis, etc., use antibiotics before surgery to prevent postoperative lesions, generally preoperative injection of penicillin 3d. 5. Take phenobarbital 0.1g 2 hours before surgery, subcutaneous injection of atropine 0.5mg half an hour before surgery to reduce the excessive secretion of oral secretions during surgery. Children's dosage should be reduced according to age. 6. Carry out missions before surgery to reduce unnecessary concerns of patients and make the operation go smoothly. Surgical procedure There are two kinds of local anesthesia tonsil stripping method and general anesthesia tonsill stripping method. (1) Local anesthesia tonsil stripping method 1. The patient generally takes a seat, the operator sits opposite the patient, and the light source is on the patient's head. 2. Inject the anesthetic to take 1% procaine 20ml, add 4-6 drops of 1:1000 adrenaline solution, then extract half of the above anesthetic with 10ml syringe, use tongue depressor in front of the tongue 2/3 and back 1/3 junction is pressed to make the pharynx exposed clearly. In the upper, middle and lower parts of the tongue arch, 3 to 4 ml of anesthetic are injected respectively. First, the needle tip is inserted into the mucosa and injected a little, and then the needle tip is punctured around the tonsil. In. Injected anesthetics, in addition to anesthesia, can separate the tonsils from the tonsils. A small amount of anesthetic is also injected between the upper part of the pharyngeal arch and the upper pole of the tonsil, and the opposite side is also anesthetized according to this method. At this time, the patient felt swollen in the throat and inconvenienced in swallowing. After the injection is completed, the operation is performed after 5 minutes. 3. Incision with a tonsil knife along the lingual arch, 1 to 2 mm away from the free edge, cut from the upper pole of the tonsil to the root of the tongue, then bypass the upper pole, extend the incision, cut the pharyngeal arch. However, it is necessary to pay attention to the operation, the incision should not be too deep, and it is only necessary to cut the mucosa. If it is cut too deeply, it will damage the pharyngeal muscles. Or cut into the tonsil tissue, are easy to cause bleeding and wound infection. 4. Peel the tonsil tonsil stripper from the incision of the tongue and arch, first peel the tongue and the front of the tonsil, then push the upper pole of the tonsil down, use the tonsils to clamp the upper part of the tonsils, while using the stripper down Squash the peach to separate it from the tonsil socket until a small pedicle is left in the lower pole. When peeling off, the stripper should not be dug deep into the socket to avoid damage to the pharyngeal muscles or blood vessels and cause bleeding. 5. The entrapment of the snare is to insert the tonsil gripper at the tonsil snare, and the tonsil gripper clamps the tonsil inward and upward, and the snare is placed outwardly to cover the pedicle, and the snare is tightened to remove the tonsil. The cotton ball was clamped with a tonsil hemostat and placed in the tonsil socket to stop bleeding. At the same time, the tonsils were examined for completeness and tissue damage. 6. Inspect the wound with a tonsil hook to pull the tongue out of the tongue, check the presence or absence of bleeding in the tonsil socket, or residual tonsil tissue, especially in the lower triangular folds of the tonsils, more lymphoid tissue, if not removed, after surgery Hypertrophy and hyperplasia, even inflammation. In addition, the residue of the lower pole can often cause postoperative bleeding. If there is active bleeding, you must stop it properly. (2) General anesthesia tonsil stripping method 1. Take the supine position and open the mouth with a mouth opener to make the pharynx clear. And under the mucosa of the tongue and the pharyngeal arch, 1% procaine plus 1:1000 adrenaline was added to achieve the purpose of stopping bleeding. The specific operation of the operation was the same as local anesthesia. However, the patient's head position is inverted, so the direction of the surgery is opposite to that of local anesthesia. 2. Attention should be taken to keep the respiratory tract unobstructed during the operation to prevent suffocation. Stop bleeding thoroughly to prevent postoperative bleeding. 3. After removal of the tonsil, it is advisable to use a proliferator resection device and a proliferator splitting spoon for proliferative scraping and to stop bleeding with a ball.