Tonsillectomy Part 5 - Complications of Tonsillectomy

⚠️ Complications of Tonsillectomy

Continued from Part 4 - Tonsillectomy Procedure & Post-operative care.

In this part of the tonsillectomy series, we discuss the complications of tonsillectomy.

📌 Classification of Complications of Tonsillectomy

Complications of tonsillectomy are broadly classified into:

1. Immediate complications
2. Delayed complications

🚨 Immediate Complications of Tonsillectomy

1️⃣ Primary Hemorrhage

• Definition: Bleeding occurring during surgery

• Management:

  • Pressure application
  • Ligation
  • Electrocoagulation

What are the causes of Primary hemorrhage in Tonsillectomy?

2️⃣ Reactionary Hemorrhage

What is Reactionary hemorrhage? What time period is it seen more commonly post Tonsillectomy?

• Causes:

  • Slipped ligature
  • Dislodged clot

• Management:

  • Removal of clot
  • Pressure
  • Vasoconstrictors

3️⃣ Surgical Trauma

a) Soft Tissue Injury

• Injury to:

  • Lips
  • Tongue
  • Tonsillar pillars
  • Posterior pharyngeal wall

• Cause: Faulty placement of Boyle Davis mouth gag

• Prevention: Proper placement of mouth gag

b) Uvular Edema

• Causes:

  • Excessive manipulation of uvula
  • Excessive removal of anterior tonsillar pillar

• Management: Injectable steroids

c) Dental Injury

• Missing tooth post-op → suspect aspiration

How will you manage a patient with a missing tooth postoperatively after Tonsillectomy?

4️⃣ Aspiration

• Aspiration of blood or secretions

What are the measures taking intraoperatively and postoperatively in Tonsillectomy to prevent aspiration?

5️⃣ Airway Compromise

• Causes:

  • Kinking or compression of Endotracheal tube
  • Pulmonary edema

• Management:

  • Diuretics
  • CPAP
  • Ventilatory support if required

6️⃣ Airway Fire

• Cause: Diathermy use with anesthetic gas leakage

• Prevention: Wet gauze around Endotracheal tube

How will you manage an airway fire if it happens while performing Tonsillectomy?

7️⃣ Dehydration

• Due to pain → reduced oral intake

• Common in children

• Management: Ensure adequate hydration

8️⃣ Facial Edema

• Commonly periorbital (around eyelids)

• Usually self-limiting

9️⃣ Surgical Emphysema

• Rare
• Due to injury to superior constrictor muscle

⏳ Delayed Complications of Tonsillectomy

1️⃣ Secondary Hemorrhage

What is Secondary Hemorrhage? When is it commonly seen?

• Cause: Infection (sepsis)

• Management:

  • IV fluids
  • Antibiotics
  • Blood transfusion if required

2️⃣ Infection of Tonsillar Fossa

• Common after hot tonsillectomy

• Can lead to:

  • Parapharyngeal abscess
  • Otitis media

• Halitosis present → Treat with:

  • Metronidazole
  • Penicillin group antibiotics (7–10 days)

3️⃣ Pulmonary Complications

• Causes:

  • Inhalation of blood or tissue

• Results in:

  • Pneumonia
  • Lung collapse
  • Lung abscess

• Pulmonary edema seen in children with prolonged airway obstruction

• Management: ICU care, diuretics, CPAP, ventilation

4️⃣ Scarring of Soft Palate & Pillars

• Due to excessive intraoperative injury

5️⃣ Tonsillar Remnants

• Due to incomplete removal

• Leads to recurrent infection

• Treatment: Revision tonsillectomy

6️⃣ Lingual Tonsil Hypertrophy

What are Lingual tonsils?

• Late complication
• Compensatory hypertrophy after palatine tonsil removal
• Common in children 3–7 years

7️⃣ Pharyngeal Stenosis

• Due to inflammation and adhesions

• Treatment:

  • Triamcinolone injections
  • Adhesiolysis

8️⃣ Velopharyngeal Insufficiency

• Seen in cleft palate patients
• Reason why cleft palate is a contraindication

9️⃣ Grisel’s Syndrome

What is Grisel's syndrome? What is the pathogenesis?

• Very rare but serious

• Clinical features:

  • Neck pain
  • Torticollis
  • Restricted neck movement

What are the risk factors to developing Grisel’s Syndrome?

📌 Exam Pearls

• Most common complication: Hemorrhage
• Most dangerous immediate complication: Airway compromise
• Most feared delayed complication: Secondary hemorrhage
• Rare but fatal: Grisel’s syndrome

📚 Next Topic:
Post-Tonsillectomy Hemorrhage (Primary, Reactionary & Secondary)