As we all know, tonsils are located at the crossroads of the respiratory tract and digestive tract. They are easily infected by bacteria, which can lead to related diseases. In severe cases, they may even require removal. So what are the options after tonsil surgery? Are there any sequelae? I have compiled some information about the sequelae after tonsil surgery. I hope it will be helpful to everyone!

Are there any sequelae after tonsillectomy?

1. Bleeding

Bleeding within 24 hours after surgery is primary bleeding, which is more common and mostly occurs within 6 hours after surgery. It may be due to lack of care in the surgery, residual body left behind, incomplete hemostasis, or the vasoconstrictive effect of epinephrine in the anesthetic. It may be caused by the dilation of blood vessels after disappearing; it may also be caused by small bleeding spots that were already bleeding due to pharyngeal movement, coughing or temporary increase in blood pressure, lack of vitamin C, reduced thrombin content, sudden changes in weather, etc. Promote postoperative bleeding. Secondary bleeding often occurs 5 to 6 days after surgery, mainly when the tunica albuginea begins to fall off. Bleeding occurs due to scratches caused by swallowing hard food. It can be prevented if you pay more attention. If it is secondary infectious bleeding, treatment should be strengthened, such as anti-infection.

1. If there is a blood clot in the tonsillar fossa, it should be removed and pressed with a gauze ball for 10 to 15 minutes. When checking for bleeding points, attention should be paid to the hidden areas above and below the tonsil fossa. There are bleeding points below near the base of the tongue and behind the lingual and palatine arch, which are difficult to see. If there is an obvious bleeding point, clamp it with a vascular clamp to stop the bleeding.

2. For diffuse bleeding, hemostatic powder or gelatin sponge can be applied to the bleeding area. If it is ineffective, a sterilized gauze ball can be used to fill the tonsillar fossa, sew the lingual and palatine arches and pharyngeal palatine arches with 3 to 4 stitches, and leave the gauze in the tonsillar fossa for 24 hours.

3. Sometimes the patient swallows blood and accumulates it in the stomach without being noticed. When a considerable amount is reached, sometimes he or she suddenly vomits a large amount of blood. The patient has a rapid pulse, pale complexion, cold sweats and other early shock symptoms. , measures such as rehydration, blood transfusion and hemostasis should be taken for active rescue.

4. Surgery to damage the internal carotid artery is extremely rare. If not treated in time, it can lead to death from massive bleeding. Main prevention: When peeling off tonsils during surgery, the tonsils should be peeled off close to the outside of the tonsil capsule. The separation should not be too deep. Do not use knives or scissors to cut the adherent tissue. In the event of an unfortunate event, immediate compression is required to stop the bleeding and suturing of the internal carotid artery from the outside of the neck is performed.

2. Wound infection

Patients with low resistance, lax aseptic procedures during surgery or bleeding after tonsillectomy may be complicated by wound infection. The symptoms include no albuginea growing on the wound surface, or the albuginea is dirty and incomplete, and the pharynx is congested, swollen, and has severe sore throat, sometimes accompanied by fever. Apply sufficient antibiotics and gargle with 0, 5 to 1 hydrogen peroxide.

3. Trauma

Surgery to remove tonsils will generally cause a lot of major trauma to the patient, and will also cause some symptoms, such as pain, edema, etc.

Tonsillectomy care

(1) Patients are all placed in the side-lying position. Patients under local anesthesia are instructed to drain the secretions from the mouth along the corners of the mouth and not to swallow them in order to observe whether there is bleeding. Patients under general anesthesia should pay attention to whether they have any swallowing movements before they wake up. If so, check whether there is bleeding.

(2) You can take liquid food three hours after the operation, and you can rinse your mouth with salt water after six hours. When the wound is painful, cold compress can be applied to the neck.

(3) On the second day after tonsillectomy, a layer of white film will appear on the wound surface, which is a normal reaction. The tunica albuginea begins to fall off approximately 5 to 7 days after surgery, granulations form on the wound surface, and surface epithelium begins to grow. If the albuginea appears dirty gray, you should be aware of the possibility of infection. You can use antibiotics and rinse your mouth with 0.5 to 1 hydrogen peroxide solution.

Tonsill removal surgery

Tonsill removal method under local anesthesia

1. The patient is usually in a sitting position, with the operator sitting opposite the patient and the light source on the side of the patient's head .

2. Injection of anesthetic

Take 1 20ml of procaine, add 4 to 6 drops of 1:1000 epinephrine solution, mix it, and use a 10ml syringe to withdraw half of the above-mentioned anesthetic. , use a tongue depressor to depress the junction of the front 2/3 and the back 1/3 of the tongue to expose the pharynx clearly. Inject 3 to 4 ml of anesthetic into the upper, middle and lower parts of the tongue and palate arch respectively; first prick the needle tip Inject a small amount under the mucosa, and then insert the needle tip around the tonsils. In addition to anesthesia, the injected anesthetic can also separate the tonsils from the tonsil fossa. A little anesthetic () also needs to be injected between the top of the pharyngeal and palatine arch and the upper pole of the tonsils, and the opposite side is also anesthetized in this way. At this time, the patient feels that the throat is swollen and has difficulty swallowing. After the injection is completed, wait 5 minutes before performing the surgery.

3. Incision

Use a tonsil knife along the lingual and palatine arch, 1 to 2 mm outside the free edge, cut from the upper pole of the tonsil downward to the root of the lingual and palatine arch (), and then go around After passing the upper pole, the incision is extended and the pharyngeal and palatine arches are incised. However, care should be taken during the operation that the incision should not be too deep and only the mucosa should be incised. If the cut is too deep, the superior pharyngeal constrictor muscles will be damaged. Or cutting into tonsil tissue can easily cause bleeding and wound infection.

4. Peel off the tonsils

Use a tonsil peeler from the lingual and palatine arch incision to first peel off the lingual and palatine arch from the front of the tonsils, and then press the upper pole of the tonsils downwards and use The tonsil grasping forceps hold the upper part of the tonsil, and at the same time, use the dissector to press down on the tonsil to separate it from the tonsil fossa until a small pedicle is left at the lower pole. During dissection, the dissector should not dig deep into the socket to avoid damaging the superior pharyngeal constrictor muscles or blood vessels and causing bleeding.

5. Snare removal

Insert the tonsil grasping forceps into the tonsil snare, use the tonsil grasping forceps to grasp the tonsils and pull them inward and upward, while the snare is placed outward and downward. pedicle, tighten the snare, and remove the tonsils. Clamp the cotton ball with tonsil hemostats, place it into the tonsil fossa to compress and stop bleeding, and check whether the tonsils are intact and whether there is any tissue damage.

6. Check the wound

Use a tonsil retractor to pull apart the lingual and palatine arches, and check whether there is bleeding in the tonsil fossa and whether there is any residual tonsil tissue, especially the triangular fold at the lower pole of the tonsil. , there is a lot of lymphoid tissue. If it is not removed, it can still proliferate and hypertrophy after surgery, and even cause inflammation. In addition, residual lower pole can often cause postoperative bleeding. If there is active bleeding, it must be stopped properly.

Tonsillectomy under general anesthesia

1. Take a supine position and use a mouth opener to open your mouth to expose the pharynx clearly. And inject 1 procaine plus a little epinephrine 1:1000 under the mucosa of the lingual and palatine arches and pharyngeal and palatine arches to achieve hemostasis. The specific operations of the operation are the same as tonsillectomy under local anesthesia. However, the patient's head was in an inverted position, so the direction of surgery was opposite to that during local anesthesia.

2. During the operation, attention should be paid to keeping the respiratory tract open at all times to prevent suffocation. Hemostasis must be thorough to prevent postoperative bleeding.

3. After tonsillectomy, it is advisable to use a proliferative body resector and a proliferative body dissecting spoon to perform proliferative body curettage at the same time, and use gauze balls to compress and stop bleeding.

Tonsill removal can easily lead to massive bleeding. Operators need to be particularly cautious. After the operation, they should pay attention to observe whether the patient will have other symptoms, such as fever or bleeding. Let the doctor know in time, and eat liquid food during the recovery period to prevent too hard food from causing damage to the wound.