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Background: Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malprac...
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Citations
... The LBGN is of particular concern, as several reports mentioned that injury to this nerve during tonsillectomy is among the possible causes of developing post-tonsillectomy dysgeusia. 3,4,[7][8][9][10][11] The topographical relationship between the palatine tonsils, the muscular layer of the tonsillar bed, and the LBGN (Figure 3) has been reported in the literature. 7 Anatomic variations of the location of the LBGN through cadaver studies were observed by Ohtsuka, et al. have reported that in 21.5% of 107 tongue sides dissected, the LBGN was directly in contact with the tonsillar capsule. ...
... According to a 2015 study comparing these various techniques, it was mentioned that persistent post-tonsillectomy dysgeusia was considered a rare late complication of tonsillectomy in general, and there was no mention of any technique that was documented to be superior in terms of avoiding rare complications such as post-tonsillectomy dysgeusia. 13 The LBGN may also be damaged by the mechanism of stretching and compression by depression of the tongue during oral retraction, 3,9 However, in this patient, there were no attempts to clamp inferior pole vessels nor was there prolonged depression of the tongue. Other proposed causes include lack of dietary zinc and habitual drug intake. ...
... All patients undergoing tonsillectomy must be informed about the risk of taste impairment, and this is backed up by the study of Windfuhr where it was mentioned that an adequate informed consent is necessary and should explain all complications and questions that may arise in every patient, including complications occurring with a rate of 0.1%, taking into consideration that the incidence rate of post-tonsillectomy dysgeusia previously mentioned which is 0.3% to 9%. 8,9 In conclusion, taste disturbances after tonsillectomy are rarely described in the medical literature, hence, an understanding of the surgical anatomy as well as anatomical variations of the LBGN cannot be overemphasized. It is very important to stress that trauma to the tonsillar bed, inferior pole electrodissection, clamping of inferior pole vessels, and extensive or prolonged depression of the tongue, should be discouraged in all cases of tonsillectomy. ...
The authors report a case of post-tonsillectomy dysgeusia and discuss the pathogenesis, diagnostics, as well as treatment options done in several reported cases. A 37-year-old man who was diagnosed with recurrent tonsillitis underwent bilateral palatine tonsillectomy, and on the second post-operative day, post-tonsillectomy hemorrhage ensued which required emergency hemostasis at the operating room. Intra-operative findings include active bleeding on the left tongue base, wherein hemostasis was achieved via electrodissection. After the procedure, patient noted a disturbance to taste that persisted for several months. Dysgeusia is an unusual complication of tonsillectomy, occurring in 0.3% to 9% of cases. Key words: Tonsillectomy, complications, taste disorders, dysgeusia, lingual branch of the glossopharyngeal nerve
... 16 These figures are consistent with later studies. 17,18 Tolska et al found an adult post-tonsillectomy hemorrhage rate of 14.5% at our clinic in a previous study. 19 Rates of 0.05% to 0.5% for postadenoidectomy hemorrhage have been documented. ...
Aims
Many procedures in ear, nose, and throat (ENT) day surgery are carried out under local anesthesia in Finland, whereas many other countries use general anesthesia. We investigated overstay and readmission rates in local and general anesthesia at Helsinki University Hospital.
Material and Methods
We conducted a retrospective study on ENT (n = 1011) day surgery patients within a 3-month period using the hospital’s surgery database to collect data pertaining to anesthesia, overstays, readmissions, and contacts within 30 days of surgery.
Objectives
We examined the effect of American Society of Anesthesiologists (ASA) class, age, sex, type of procedure, and anesthesia type on overstay, contact, and readmission rates.
Results
A multivariable logistic regression model included ASA class, age, sex, type of procedure, and anesthesia (local vs general). Sex, age, and type of procedure had an effect on the outcomes of overstay, readmission, or contact. With general anesthesia, 3.2% (n = 23) had an overstay or readmission compared to 1.4% (n = 4) after local anesthesia. This was mainly explained by the number of study outcomes in tonsillar surgery that was performed only in general anesthesia.
Conclusions
Day surgery could be done safely using local anesthesia, as the number of study outcomes was no greater than in general anesthesia. Sex, type of procedure, and age affected the rate of study outcomes, but ASA class and anesthesia form did not. Our overstay, contact, and readmission rates are on the same level, or lower, than in international studies.
... The last issue is the invasiveness of the maxillofacial procedures in the facial skeleton: the mandible is divided into 3-4 segments (in sagittal osteotomy with genioplasty), the maxilla is separated from the base of the skull, the periosteum is elevated from large areas of the nose walls, not to mention the Le Fort III osteotomy [34]. The possibility of potentially dangerous complications in patients with a hidden medical problem (blindness [35,36], dyspnea, anosmia, apallic syndrome [37], dyphagia, dysgeusia) is high. Orthognathic maxillofacial procedures are a common surgery with set of complications [38,39]. ...
Background: The serum suPAR level is affected in humans by it increases with age. Therefore it makes difficult interpretation and any comparison of age varied groups. The aim of this study is to find simple way to age independent presentation of suPAR serum level for maxillofacial surgery purpose. Methods: In generally healthy patients from 15 to 59 y.o. suPAR level was tested in serum before orthognathic or minor traumatologic procedures. Five ways to make the suPAR serum level assessment independent of age are proposed. Results: One way of making suPAR levels independent of age led to the result with the same statistical distribution as in the raw suPAR serum material and this distribution is the normal. Conclusion: The simple way for suPAR serum level analysis without its dependence on patient age is calculation of the index of body inflammation understood as square root of squared suPAR serum level divided by logarithm of patient age to base 10.
... 18,38 Another meta-analysis reported 71 published court verdicts after adeno-tonsillectomy with over 60% from PTH and its consequences. 39 Datta et al proposed an endoscopic grading system post adenoidectomy into; complete removal when adenoid tissue left is <20%, partial removal-when adenoid tissue left behind is between 20%-50% and sub-optimal-greater the 50% adenoidal tissue left behind. 40 We perform clotting profile on all cases for adenotonsillectomy as our regular routine pre-operatively and further group /cross match at least a unit of fresh whole blood before the procedure in the event of a need for transfusion despite the argument for and against. ...
p class="abstract"> Background: Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.
Methods: All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA.
Results: The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III & IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.
Conclusions: This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.</p
... In the case of MRSA, vancomycin administration is an ideal choice [104,105]. The administration timing for prophylactic antibiotics is 30 to 60 min before surgery as clinical guidelines recommended the given duration [106][107][108]. ...
Globally, every year, millions of surgical procedures are carried out and most of the patients experience surgical site infections (SSIs) after surgery. This general overview is aimed to find SSI incidence, risk factors, and treatment-related factors in the current scenario of literature searched. Articles from scientific databases such as Google Scholar, Medline, PubMed, and ScienceDirect were searched and extracted with keywords SSI’, surgery’, surgical infection’, wound infection’, Risk factors SSI’, Antibiotics, and Treatment. The incidence rate of SSIs is on rise in developing countries due to limited reporting which is alarming for patient safety. Various surgery-related guidelines might be helpful in the reduction of SSI incidence. A full assessment of patients before surgery are needed through various available parameters; especially, rational use of antibiotics may minimize the risk of misuse. Healthcare-associated infections need much attention and awareness as the situation is much alarming.
... It is possible to localize lesions in addition to blood vessels, and the specificity could be improved with topical fluorescence or absorption contrast agents. The method also may be useful for identifying operative and postoperative bleeding [29]. ...
Diffuse optical imaging through centimeters of tissue has emerged as a powerful tool in biomedical research. However, applications in the operating theater have been limited in part due to data set requirements and computational burden. We present an approach that uses a small number of optical source-detector pairs that allows for the fast localization of arteries in the roof of the mouth and has the potential to reduce complications during oral surgery. The arteries are modeled as multiple-point absorbers, allowing localization of their complex shapes. The method is demonstrated using a printed tissue-simulating mouth phantom. Furthermore, we use the extracted position information to fabricate a custom surgical guide using 3D printing that could protect the arteries during surgery.
... A specified analysis on request by the author [26] confirmed the finding, that patients younger than 20 years of age were mostly female and patients older than 20 years of age were male (Figure 21). ...
... Incisional drainage and abscess tonsillectomy; age distribution 3.5.6.1 Male patients in 2010 [26] Abscesstonsillectomy prevailed as treatment modality with ID increasingly performed beyond the age of 15 ( Figure 25). ...
Background: Tonsillectomy rates vary considerably among different states, regions, and times. This study was conducted to identify the prevalence of “chronic” tonsillitis, peritonsillar abscess, hypertrophy of the tonsils with and without adenoids in absolute and relative numbers in an 80 million people nation. Moreover, the number and rates of different surgical procedures to resolve either “chronic” tonsillitis, peritonsillar abscess, or upper airway obstruction due to (adeno)tonsillar hypertrophy over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy, abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was calculated and analyzed in relation to age and gender.
Material and methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013.
Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142,574 (in 2000) to 87,624 in 2013 (38.5%). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833,896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120,993 in 2006 to 84,332 procedures in 2013 (30.3%). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10,000 in 2010 to 58.68 per 10,000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10,000 to 10.90 per 10,000. In contrast, an increasing number of tonsillotomies was observed between 2007 (4,659 procedures) and 2013 (11,493). The cumulated number of procedures was 59,049. A constant number of 15,000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100,000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to the transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced in 5.98% of all patients after 245,721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06% vs. 7.02%). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only.
Conclusion: Chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continually, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance in insurance companies and authorities in the national health system of an 80 million people nation. (Tab. 1)
... [25,26] Additionally, it was increasingly perceived that the procedures did not warrant the risk of complications associated with surgical and postsurgical conditions. [27][28][29] Therefore, orthodontists and otolaryngologists need more convincing evidence to prove that adenoidectomy and tonsillectomy will have a positive effect on children with airway obstruction, implicated in incidences of mouth-breathing and dental deformity. Nonetheless, the debate concerning the role played by the adenoidectomy or tonsillectomy-mediated reversal of dental deformities in cases of airway obstruction in children is still ongoing. ...
Background:
Children with severe airway obstruction tend to have a vertical direction of growth, class II malocclusion, and narrow arches. Adenoidectomy and tonsillectomy were recommended for the promotion of balanced dentition growth in these children.The aim of this study was to determine the effect of adenoidectomy and tonsillectomy on the growth of dental morphology in children with airway obstruction.
Methods:
A comprehensive search of the Medline, Embase, Web of science, and OVID databases for studies published through to January 17, 2016 was conducted. Prospective, comparative, clinical studies assessing the efficacy of adenoidectomy, or tonsillectomy in children with airway obstruction were included. The weighted mean difference (WMD) and 95% confidence interval (CI) were used for continuous variables. Forest plots were drawn to demonstrate effects in the meta-analyses.
Results:
Eight papers were included in our study. We found that adenoidectomy and tonsillectomy led to a significant change in nasal-breathing in children with airway obstruction. Children with airway obstruction had a significantly narrower posterior maxillary dental arch than children without airway obstruction (WMD = -0.94, 95% CI [-1.13, -0.76]; P < 0.001). After surgery, these children still had a significantly narrower dental arch than the nasal-breathing children (WMD = -0.60, 95% CI [-0.79, -0.42]; P < 0.001). In terms of dental arch width, malocclusion, palatal height, overjet, overbite, dental arch perimeter, and arch length, a tendency toward normalization was evident following adenoidectomy or tonsillectomy, with no significant differences evident between the surgical group and the normal group. The small number of studies and lack of randomized controlled trials were the main limitations of this meta-analysis.
Conclusions:
Following adenoidectomy and tonsillectomy, the malocclusion and narrow arch width of children with airway obstruction could not be completely reversed. Therefore, other treatments such as functional training or orthodontic maxillary widening should be considered after removing the obstruction in the airway.
... [71] A guideline for histological examination of adenoids and tonsils does not exist and the cost benefit ratio of routine histology appears questionable. [72] However, due to legal and ethical reasons, histological analysis can be done. [4] In conclusion, adenoid tissue plays an important role in the immune system. ...
Adenoid is a secondary lymphoid organ located in the nasopharynx. Due to its location, it plays an important role in the host defense of the upper respiratory tract. Immunoglobulin G3 and immunoglobulin A1 antibodies are prevalent antibodies in the adenoid tissue. Adenoidal hypertrophy is a common condition in children causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion. Currently, adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide. Although there is still poor evidence in the literature, recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome are considered to be the main indications of adenoidectomy. Adenoidectomy can be carried out with several techniques and instruments. Although rare, surgery possesses some risks and may cause emotional distress both for the patient and the family. Non-surgical treatments such as intranasal steroids are also used in the treatment of adenoid hypertrophy. In this review, we discuss the current literature on the adenoid function, adenoidectomy indications, and treatment of adenoid hypertrophy.
... Generally current indications of tonsillectomy are infection, upper airway obstruction, suspected neoplasia, and asymmetric tonsillar hypertrophy [2]. Following surgery, complications such as pain, hemorrhage, velopharyngeal insufficiency (VPI), cervical spine complications, airway obstruction and pulmonary edema, nasopharyngeal stenosis, foreign body aspiration, low fever, and otalgia may develop, management of which is provided by different methods [2]. ...
... Generally current indications of tonsillectomy are infection, upper airway obstruction, suspected neoplasia, and asymmetric tonsillar hypertrophy [2]. Following surgery, complications such as pain, hemorrhage, velopharyngeal insufficiency (VPI), cervical spine complications, airway obstruction and pulmonary edema, nasopharyngeal stenosis, foreign body aspiration, low fever, and otalgia may develop, management of which is provided by different methods [2]. One of the most common morbidities is pain. ...
Objectives
Tonsillectomy is one of the most common operations performed in pediatric population. One of the most prevalent tonsillectomy complications is early or delayed post-operative hemorrhage. Other important morbidity is post-operative pain. Historically, honey has been used for wound control, reducing the inflammation, and healing acceleration. The aim of this study is to investigate the effect of honey on reducing pain after tonsillectomy in children 5-15 years old.
Methods
After tonsillectomy, 80 patients were randomly divided in two equal groups. Patients in the first group were treated with antibiotic and acetaminophen, while those in the second group were treated with antibiotic, acetaminophen and honey. Data was gathered via a questionnaire and observation of tonsillar bed healing. Data was analyzed by SPSS17 software and related tests.
Results
Pain comparison between two groups showed that the average time required for pain relief in patients who received honey was less than the control. The pain intensity was higher during the first 9 days post-operatively in control group. Results also showed that acetaminophen consumption in patients who received honey is lower. In the case group, the average time to resume regular diet and the frequency of awakening at night is significantly less than the control group.
Conclusion
Honey administration after tonsillectomy has valuable effect in pain relief and it can be used as an adjunctive regimen after surgery for better pain control.
