patients
& method

study
design: A 
prospective  descriptive  study 
of  100 cases of tonsillectomy carried
out  in ENT center in Sulaimaniyah
teaching hospital over a period of 8 months (Jan .2017-Aug. 2017). to compare
the two methods of securing the lower pole ,snaring & ligation regarding
the  post tonsillectomy complication

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Inclusion
criteria:

·       
patients of any
age

·       
chronic
tonsillitis

·       
sleep apnea
syndrome

exclusion
critria:

·       
adenoid
hypertrophy

·       
patients with
episode of acute tonsillitis

·       
quinsy

·       
upper &
lower respiratory tract infection

·       
parent refused
to participate

·       
patient with bad
follow up

·       
history of coogulopathy
disorder

·       
history of immunodeficiency
disorder

·       
orofasial anomaly
as submucous cleft palate.

·       
Chronic
systemic illnesses as DM, 
epilepsy, heart failure

·       
tonsillar unilateral
enlargement

·       
procedure part
of palatoplasty

·      
Pregnancy
and lactation.

 

sampling:

convenient
sample of 100 patients of different ages ,complaining of chronic tonsillitis prepared
for tonsillectomy  was taken,  after dissection ,the tonsil on the right
side was removed by a snare ,but on the left side the lower pole secured by
ligation method

Data
collection:

the
data collected pre & postoperatively directly from  the patient or their parents filling of the
quitionnaire of this study. Each case after being screened from the outpatient
department  & by ENT specialists of
ENT center at Al  Sulaimaniya teaching
hospital the patients were addmitted one day before the operation underwent history
taking include demographic data, otolaryngologic symptoms, past history, and family
& drug history sp for drugs as ibuprofen, aspirin, warfarin,  ENT, examination. All the patients investigated
to determine their fitness for general anaesthesia and the procedure.
Haemoglobin level, viral screening and coagulation profile was tested in all
the patients .Each patient or their parent signed an informed consent regarding
the operation, & the possible complications. next day the patient transferred
to operation  room underwent
tonsillectomy operation, the technique was uniform to all the patients of various
ages operated by the same surgeon using cold steel dissection. the procedure
done  under general anesthesia using
endotracheal intubation. The patients were placed in supine position with a
sand bag under  the shoulders (Rose
Position).The mouth was held open by a Boyle’s Davis Gag supported by Draffin
Bipod Stand. the tonsil was grasped with the Dennis Browne tonsil holding
forceps and retracted medially ,the mucosa is then incised using  tonsil scissors Then
the peritonsillar loose areolar plane was
identified .the tonsil were dissected 
using a gwynne evans dissector until reaching the lower pole which is
crushed using negus tonsil artery forceps before being cut with the same tonsil
scissors . and silk ties were used to secure hemostasis . The fossa was packed
with cotton swabs on the right side theme things
done but the  Inferior pedicle was snared
with Eve’s snare. bleeders were secured by diathermy or ligated. the mouth gag is then relaxed for 3 minutes,
the orpharynx re-ecxpected for evidence of bleeding & the procedure is
terminated.

The
operative time was measured from the start of palatoglossal incision to the
attainment of hemostasis and was recorded separately for each side. The time
taken to operate on each side was recorded in minutes.

after
operation,the patients were taken to the recovery room, All the patients  discharge
after recive   instructions about eating ice cream and cold fluids
& deit  during the 1st 24 hours then
shifting to warm fluid diet and back to normal diet gradually within three days
& received analgesics & prophylactic
antibiotic therapy in the postoperative period for 7 days.

follow
up:

the
paiets were followed for postoperative complication through direct interview or
by cell phone for 4 periods, 1st, 7th,
14th & after 1m asking about pain, fever,
& doing otolaryngologic examination to
detect evidence of infection in the tonsillar bed and the occurrence of post-tonsillectomy
bleeding & looking for the presence of tonsillar remnant. the patient or their
 family given instruction  to present to our emergency department if if
they had any comlication occured & call the researcher

Bleeding:
Each bleed was graded as

·       
Minor bleed as
blood-tinged sputum ,no action needed apart from observation.

·       
Moderate bleed ,there
is blood clot on  inspection, non
surgical intervention, I.V fluid, clot removal, I.V. antibiotics .

·       
major bleed :bleeding
actively under examination (required exploration, blood transfusion).

Pain
The
patients were asked about  the intensity
of their postoperative pain for assessment as:  mild , moderate, severe

tonsillar
remnant. During follow up,examination done looking for  smoothness of tonsillar fossa

the questionnaire
contain the following information:

-demographic
information: name, age, sex,, address

-preoperative sign
& symptoms: fever, sorethoat, odenophyphagia,  dysphagia, otalgia, cough, trismus, enlarged
tonsil, cervical LA

-time of operation

posttonsillectomy
complications: bleeding, pain, fever, tonsillar remnant

x

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