Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Management of Adenoids Tonsil PowerPoint PPT presentation
TREATMENT OF ADENOIDS
When symptoms are not marked ,
breathing exercises, decongestant
nasal drops and antihistaminics for
any co-existent nasal allergy can cure
the condition without resort to surgery
When symptoms are marked,
adenoidectomy is done.
Adenoidectomy
Adenoidectomy may be indicated
alone or in combination with
tonsillectomy
Adenoids are removed first and the
nasopharynx packed before starting
tonsillectomy
INDICATIONS
1. Adenoid hypertrophy causing snoring, mouth
breathing, sleep apnoea syndrome or speech
abnormalities, i.e. (rhinolalia clausa)
2. Recurrent rhinosinusitis
3. Chronic otitis media with effusion associated
with adenoid hyperplasia
4. Recurrent ear discharge in benign CSOM
associated with adenoiditis/adenoid hyperplasia.
5. Dental malocclusion. Adenoidectomy does not
correct dental abnormalities but will prevent its
recurrence after orthodontic treatment.
CONTRAINDICATIONS
1. Cleft palate or submucous palate.
2. Haemorrhagic diathesis.
3. Acute infection of upper respiratory
tract.
ANAESTHESIA
Always general, with oral endotracheal
intubation
POSITION
Rose's position
Patient lies supine with head extended by
placing a pillow under the shoulders. A rubber
ring is placed under the head to stabilize
it.Hyperextension should always be avoided
STEPS OF OPERATION
Boyle?Davis mouth gag is inserted
Before actual removal of adenoids, nasopharynx
should always be examined by retracting the soft
palate with curved end of the tongue depressor and by
digital palpation, to confirm the diagnosis, to assess
the size of adenoids mass and to push the lateral
adenoid masses towards the midline
A laryngeal mirror helps to assess the size and extent
of adenoid mass
Proper size of "adenoid curette with guard" is
introduced into the nasopharynx till its free
edge touches the posterior border of nasal
septum and is then pressed backwards to
engage the adenoids.
At this level, head should be slightly flexed to
avoid injury to the odontoid process
With gentle sweeping movement, adenoids are
shaved off
Lateral masses are similarly removed with
smaller curettes; small tags of lymphoid tissue
left behind are removed with punch forceps
Haemostasis is achieved by packing the area for
sometime.
Persistent bleeders are electrocoagulated under vision
COMPLICATIONS
Haemorrhage
Injury to eustachian tube opening
Injury to pharyngeal musculature and vertebrae.
Grisel syndrome.
Velopharyngeal insufficiency
Nasopharyngeal stenosis
Recurrence
TREATMENT OF ACUTE TONSILLITIS
Patient is put to bed and encouraged to take plenty of
fluids
Analgesics (aspirin or paracetamol) are given
according to the age of the patient to relieve local pain
and bring down the fever.
Antimicrobial therapy. Most of the infections are due
to Streptococcus and penicillin is the drug of choice.
Patients allergic to penicillin can be treated with
erythromycin. Antibiotics should be continued for 7?
10 days.
TREATMENT OF CHRONIC
TONSILLITIS
Conservative treatment consists of attention to
general health, diet, treatment of coexistent infection
of teeth, nose and sinuses
Tonsillectomy is indicated when tonsils interfere with
speech, deglutition and respiration or cause recurrent
attacks
Tonsillectomy
INDICATIONS
ABSOLUTE
? Recurrent infections of throat.
? Peritonsillar abscess
? Tonsillitis
? Hypertrophy of tonsils
? Suspicion of malignancy
RELATIVE
oDiphtheria carriers, who do not respond to
antibiotics.
oStreptococcal carriers
oChronic tonsillitis with bad taste or halitosis
which is unresponsive to medical
treatment.
oRecurrent streptococcal tonsillitis in a
patient with valvular heart disease.
AS A PART OF ANOTHER OPERATION
Palatopharyngoplasty which is done for
sleep apnoea syndrome.
Glossopharyngeal neurectomy. Tonsil
is removed first and then IX nerve is
severed in the bed of tonsil.
Removal of styloid process.
CONTRAINDICATIONS
Haemoglobin level less than 10 g%.
Presence of acute infection in upper respiratory
tract, even acute tonsillitis
Children under 3 years of age
Overt or submucous cleft palate
Bleeding disorders, e.g. leukaemia, purpura,
aplastic anaemia or haemophilia.
At the time of epidemic of polio.
Uncontrolled systemic disease, e.g. diabetes,
cardiac disease, hypertension or asthma.
Tonsillectomy is avoided during the period of
menses
ANAESTHESIA
Usually done under general anaesthesia with
endotracheal intubation. In adults, it may be done
under local anaesthesia.
POSITION
? Rose's position, i.e. patient lies supine with head
extended by placing a pillow under the shoulders.
A rubber ring is placed under the head to stabilize
it .Hyperextension should always be avoided
STEPS OF OPERATION (DISSECTION
AND SNARE METHOD)
. Boyle?Davis mouth gag is introduced and opened. It
is held in place by Draffin's bipods or a string over a
pulley
Tonsil is grasped with tonsil-holding forceps and
pulled medially.
Incision is made in the mucous membrane where it
reflects from the tonsil to anterior pillar. It may be
extended along the upper pole to mucous membrane
between the tonsil and posterior pillar
A blunt curved scissor may be used to dissect the
tonsil from the peritonsillar tissue and separate its
upper pole
Now the tonsil is held at its upper pole and traction
applied downwards and medially. Dissection is
continued with tonsillar dissector or scissors until
lower pole is reached
Now wire loop of tonsillar snare is threaded over the
tonsil on to its pedicle, tightened, and the pedicle cut
and the tonsil removed.
A gauze sponge is placed in the fossa and pressure
applied for a few minutes
Bleeding points are tied with silk. Procedure is
repeated on the other side.
COMPLICATIONS
IMMEDIATE
Primary haemorrhage
Reactionary haemorrhage
Injury to tonsillar pillars, uvula, soft palate,
tongue or superior constrictor muscle due to bad
surgical technique
Injury to teeth.
Aspiration of blood.
Facial oedema.
Surgical emphysema.
DELAYED
Secondary haemorrhage.
Infection- parapharyngeal abscess or otitis
media
Lung complications
Scarring in soft palate and pillars
Tonsillar remnants.
Hypertrophy of lingual tonsil.
THANK YOU
This post was last modified on 12 August 2021