--- title: "Tonsillectomy Part 5 - Complications of Tonsillectomy" description: "ENT notes on Tonsillectomy Complications - immediate and delayed complications." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tonsillectomy-complications" categories: ["Pharynx", "Short Questions in ENT", "Surgery"] video: "https://www.youtube.com/watch?v=Oxte-T8-vbI" image: "https://media.theentresident.com/og-images/tonsillectomy-complications.png" --- # Tonsillectomy Part 5 - Complications of Tonsillectomy ENT notes on Tonsillectomy Complications - immediate and delayed complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=Oxte-T8-vbI ## ⚠️ Complications of Tonsillectomy Continued from **Part 4** - [Tonsillectomy Procedure & Post-operative care](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-procedure-postop-care.md). 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)](https://www.theentresident.com/ent-notes-lectures/post-tonsillectomy-hemorrhage-reactionary-secondary.md) --- ## About This Note This free ENT note on Tonsillectomy Part 5 - Complications of Tonsillectomy was written by Dr. Mausumi Das and is paired with a corresponding video lecture. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tonsillectomy-complications When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## Related Notes by Category - Pharynx: https://www.theentresident.com/ent-notes-lectures/category/pharynx.md - Short Questions in ENT: https://www.theentresident.com/ent-notes-lectures/category/short-questions-in-ent.md - Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md ## About The ENT Resident The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students. Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself. 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