Tonsils MCQs

Bleeding after tonsillectomy can be primary (within 24 hours after the operation) or secondary (after 24 hours until 2 weeks). The most likely explanation for secondary bleeding is infection with Streptococcus in the granulating tonsil bed. Treatment depends on the severity and potential cause of the bleed. Antibiotics are advised for secondary bleeding. Severe primary or secondary bleeds need to be controlled in there.

If a patient is actively bleeding, the patient should be taken urgently for control of the hemorrhage. Until the patient is transferred to the operating room, if hemorrhaging is significant, direct pressure, either with a throat pack or gauze, should be applied to the tonsillar fossa if the patient is cooperative and an intravenous line can be started before the patient is shifted to the OT.

Palatopharyngeus muscle does not form the bed of the tonsil. Bed of the tonsil- Formed by the superior constrictor and styloglossus muscles . The glossopharyngeal nerve and styloid process , if enlarged, may lie in relation to the lower part of tonsillar fossa. Both these structures can be surgically approached through the tonsil bed after tonsillectomy. Internal carotid artery lies one inch lateral to the tonsillar bed Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 303

Secondary hemorrhage occurs mostly after 5 th day of tonsillectomy. Hemorrhage of tonsillectomy- Primary hemorrhage – during surgery Reactionary hemorrhage - Within 24 hours of tonsillectomy. It is due to slippage of ligature and it should be immediately re-explored under GA. Secondary hemorrhage - after 5 th day of tonsillectomy. It is due to infection of tonsillar fossa and is managed with I/V antibiotics. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 506

This is a case of reactionary hemorrhage. Hemorrhage of tonsillectomy- Reactionary hemorrhage - Within 24 hours of tonsillectomy. It is due to slippage of ligature and it should be immediately re-explored under GA. Primary hemorrhage – during surgery Secondary hemorrhage - after 5 th day of tonsillectomy. It is due to infection of tonsillar fossa and is managed with I/V antibiotics. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 506

This is a case of secondary hemorrhage . Secondary hemorrhage is seen after 5 th day of tonsillectomy. It is due to infection of tonsillar fossa and is managed with I/V antibiotics. Reactionary hemorrhage is seen after 24 hours of tonsillectomy. It is due to slippage of ligature and it should be immediately re-explored under GA. Primary Haemorrhage is during surgery Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 506

The most common serious complication of tonsillectomy is delayed hemorrhage. If a patient is actively bleeding, the patient should be taken urgently for control of the hemorrhage. Until the patient is transferred to the operating room, if hemorrhaging is significant, direct pressure, either with a throat pack or gauze, should be applied to the tonsillar fossa if the patient is cooperative. Control of hemorrhage was historically managed with suture ligation, but suction cautery is more routinely performed

Secondary haemorrhage: It is a delayed complication of tonsillectomy. Usually seen between the 5 th -10 th post operative day. It is the result of sepsis and premature separation of the membrane. Usually, it is heralded by bloodstained sputum but may be profuse. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page Number-506.