3-Pharynx. Operation of The Pharynx

Prof. Dr.
Mohamed Talaat ELGhonemy

ADENOIDECTOMY
Indications: enlarged
adenoid causing symptoms.
Contra-indication: cleft palate to avoid VPI.

Complications:
1-Hemorrhage
a) Primary hemorrhage during the operation is due to: blood diseases,
injury of mucosa and muscles, aberrant vessels and incomplete
removal.
b) Reactionary hemorrhage within the first 24 hours after the operation.
c) Secondary hemorrhage due to secondary infection. It is treated by
posterior nasal pack and antibiotics.
2- Pulmonary complications:
Inhalation of blood or a small piece of adenoid: causing lung collapse and
later an abscess.
3-Injury of:
a) Eustachian tube: causes otitis media and deafness.
b) Palate: causes regurgitation and nasal tone (VPI).
4- Recurrence: due to incomplete removal.

TONSILLECTOMY
Indications of tonsillectomy:
1. Recurrent acute attacks, more than 5 per year.
2. One attack of peritonsillar abscess (Quinsy).
3. Marked enlargement of the tonsils, interfering with
respiration and deglutition.
4. Chronic tonillitis:
- Sepic focus
- Local signs of chronic tonsillitis:
a) The crypts are irregular and ooze pus on pressure by a
tongue depressor.
b) Irregularity of the shape and size of the tonsils.
c) Congestion of the anterior pillars.
d) Enlarged jugulo-digastric lymph gland draining the
tonsils.
5.Tumours of tonsils.
Contra-indications:
Absolute:
Blood diseases: as haemophilia, purpura or leukaemia.
Relative:
1.During acute attack of acute tonsillitis
2. Recent attack and upper respiratory infections
(wait 3 weeks).
3. During rheumatic activity with high sedimentation rate.
4. During epidemics, specially of poliomyelitis.
5. During an active general disease as diabetes or
hypertension.
6. Pregnancy and menstruation.
Septic focus
 A focus of infection which causes a state of

toxaemia and bacteraemia due to absorption of
toxic material.
 Chronic tonsillitis causes rheumatic
manifestations, endocarditis, nephritis, arthritis,
prostatitis, iritis or optic neuritis.
 Sites: Tonsils, teeth, sinuses, appendix, gall
bladder, prostate and fallopian tubes.
Laboratory investigations:
1.CBC: for anemia, leukemia, purpra.

2. ESR: 5-10 mm./ lst hour, 10-15 mm./ 2nd hour.
3. Coagulation profile:
a) Bleeding time: Normal 1-3 min.
b) Coagulation time: Normal 3-6 min
c)Prothrombin time (12 second) and conc. 100%.
4- Urine should be free of albumin and sugar.

Post-operative care
1- Position: Patient should lie on his side with his
knees flexed to: allow drainage, prevent inhalation
of blood or vomitus, and prevent falling back of the
tongue.
2- Observe respiration.
3- Observe for bleeding, rising pulse rate, lowering of
B.P or vomiting; brown altered blood indicates
hemorrhage and swallowing of blood.
4- Extubation when the patient coughs or swallows,
i.e. when reflexes return.
5- Diet on the first day consists of fluids and ice-
cream then semisolids.
6- Antibiotics and analgesics are given for 7 days.
Complications of tonsillectomy:
Anesthetic complications:
a) Laryngeal and broncheal spasm.
b) Aspiration of vomitus and regurge.
c) Respiratory and cardiac arrest.
Treatment:
a) Adequate airway.
b) Oxygen.
c) Artificial ventilation.
d) Cardiac massage.
Hemorrhage
A) Primary hemorrhage: Bleeding during the operation.
Cause: Operating on a patient with a contraindication.
Treatment:
1- Ligate the vessels.
2- Give blood transfusion when needed.
B) Reactionary hemorrhage: bleeding within 24 hours after the operation.

Causes: Increased blood pressure, slipped ligature or dislodged clot.
Treatment: Ligate the bleeding points under general anesthesia.
C) Secondary hemorrhage: Bleeding after the 6th to the 10th day.

Causes: Sepsis leading to sloughing of vessels and tissues.
Treatment:
1. Pack the bed of the tonsils with gauze and suture the pillars over it, as
tissues are too friable to be ligated.
2- Sedation.
3- Antibiotics.
4. If not stopped, consider external carotid artery ligation.
Pulmonary complications
Respiratory obstruction: due to
-The tongue falls backwards: pull the tongue or
mandible forwards.
-Inhalation of foreign bodies (cotton), blood or
vomitus: suction.
-Extubation spasm: suction and oxygen.
Aspiration pneumonia and lung abscess:
Cause: Inhalation of foreign bodies, blood or vomitus.
Treatment: bronchoscopic aspiration and massive
antibiotics.
 Injury of: Palate, teeth, uvula, lips and
dislocation of TMJ.
 Incomplete removal.
 Infection:
A) General: bacteraemia causing exacerbation
of arthritis and nephritis.
B) Local:
1. Severe wound sepsis.
2. Acute otitis media.
3. Cervical lymphadenitis.
4. Parapharyngeal abscess.
Thank you

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Prof. Dr.

Mohamed Talaat ELGhonemy

Contra-indication: cleft palate to avoid VPI.

4- Recurrence: due to incomplete removal.

 A focus of infection which causes a state of

1.CBC: for anemia, leukemia, purpra.

4- Urine should be free of albumin and sugar.

B) Reactionary hemorrhage: bleeding within 24 hours after the operation.

C) Secondary hemorrhage: Bleeding after the 6th to the 10th day.

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