Tonsillectomy | Purpose, Contraindications, Procedure, Recovery and Complications

Preparations of tonsillectomy surgery

Before the surgery, a good preparation for the patient can help in lessen postoperative risks, and to ensure a speedy recovery.

History

The clinician should have a full detailed history from the patient about

    • Full medical history especially diseases that may causes bleeding disorders
    • Medications including blood thinning like aspirin
    • Family history of the patient especially if there were an allergic reaction to anesthesia
    • All history of patient allergy

In the adults, the patient would be advised to stop smoking prior to the surgery, and all his medications doses would be revised with his doctor.

In pediatrics, the child should understand what he will be going through and should be supported and reassured by his parents or caregivers. It is preferable for the child to stay with his parents before and after the surgery if possible. A brief description to the child that he may feel some sore throat postoperatively for a brief time would be beneficial.

Laboratory investigation before tonsillectomy

Coagulation profile is essential before the surgery; according to the American academy of otolaryngology-Head and neck surgery foundation recommends doing a full coagulation profile for all the patient before tonsillectomy.

In a study by Gabriel et al. to assess the relationship between patients’ history and coagulation test results in pediatric age group undergoing tonsillectomy. The study showed that in 4% of the children with abnormal coagulation test results, the history taken from those children before the surgery was not correlated with their test results. The authors recommended taking a full detailed history before the surgery and performing a complete coagulation profile to all patients before the surgery.

Other tests include:

    • Complete blood picture (CBC)
    • Urine analysis
    • Liver function tests
    • Kidney function tests

Images before tonsillectomy surgery

Most patients do not require specific imaging before tonsillectomy except patients with suspected malignancy; may need to undergo a CT scan or MRI imaging. In patients with down syndrome, cervical spine imaging is important to evaluate for C1-C2 subluxation. There is other routine imaging that may be needed before the surgery.

Chest X-Ray

Chest X-Ray helps in diagnosing infections, to spot any abnormality in patient’s lung or heart that may necessitate a further investigation.

Electrocardiogram

It monitors the electric activity of the heart to exclude any cardiac abnormality that may compromise the anesthesia and the surgery.

Histology of the tonsils tissue

Examining the tonsils tissues after tonsillectomy is not recommended except in the following cases:

    • Malignancy is suspected
    • If there were non-symmetrical enlargements of the tonsils