--- title: "Tonsillectomy Part 4 - Procedure & Post operative care" description: "ENT notes on Tonsillectomy - Procedure & Post operative care." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/tonsillectomy-procedure-postop-care" categories: ["Pharynx", "Surgery"] video: "https://www.youtube.com/watch?v=h39yrMd9m8s" image: "https://media.theentresident.com/og-images/tonsillectomy-procedure-postop-care.png" --- # Tonsillectomy Part 4 - Procedure & Post operative care ENT notes on Tonsillectomy - Procedure & Post operative care. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=h39yrMd9m8s ## 🩺 Tonsillectomy: Surgical Steps & Post-Operative Care Continued from **Part 3** - [Hot Tonsillectomy vs Interval Tonsillectomy](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-types-hot-interval.md). In this post, we continue the **tonsillectomy series** and discuss: - Step by step surgical procedure of tonsillectomy - Post operative care and patient advice This topic is **high yield for viva and practical exams**. --- ### 🔹 Anesthesia and Pre-operative Preparation - Tonsillectomy is performed under general anesthesia - **Endotracheal intubation** is mandatory - In pediatric patients, **informed consent** is taken from parents 📌 **Important Consent Point** - Examine for **loose teeth** - If present, **consent for removal** must be taken → Prevents medicolegal issues if a tooth dislodges intra-operatively --- ### 🔹 Patient Positioning - Rose’s Position - Patient lies **supine** - **Sandbag / head ring** placed under shoulders - Head extended at **atlanto-occipital joint** - Neck extension with head supported > What are other surgeries where Rose's position is used? --- ### 🔹 Steps of Tonsillectomy - Dissection and Snare Method **1️⃣ Mouth Opening and Exposure** - Insert **Boyle Davis mouth gag** - Retract tongue adequately without injuring posterior pharyngeal wall - Fix gag using **Draffin’s bipod stand** - Insert **wet throat pack** to prevent aspiration **2️⃣ Grasping the Tonsil** - Hold tonsil at **upper pole** using **Dennis Brown tonsil holding forceps** - Pull tonsil **medially** - Identify plane between: - Tonsil - Anterior tonsillar pillar **3️⃣ Incision** - Make incision in mucosa between tonsil and anterior pillar - Use **Waugh's forceps** - Extend incision from upper pole to lower pole **4️⃣ Dissection** - Use **Mollison’s dissector** - Dissect tonsil from upper pole → lower pole - Sharp dissection with scissors if: - Fibrosis - Scarring - Adhesions present **5️⃣ Snaring the Lower Pole** - Apply **Eve’s tonsillar snare** - Encircle lower pole pedicle - Snare and remove tonsil **6️⃣ Hemostasis** - Pack tonsillar fossa with gauze - Apply pressure - Identify bleeding points - Ligate or cauterize if required **7️⃣ Completion** - Repeat procedure on opposite side - Clear: - Postnasal space - Oropharynx - Laryngeal inlet - Release mouth gag slowly - Recheck lower pole for bleeding - Remove throat pack - 🚩 **Count all swabs before closure** --- ### 🔹 Post-Operative Care After Tonsillectomy 🛏️ **1. Position** - **Left lateral position** - Head kept low - Allows drainage of blood and secretions - Prevents airway obstruction **📊 2. Monitoring** - Monitor **every 4 hours**: - Pulse - Blood pressure - Respiratory rate - Watch for signs of bleeding: - Tachycardia - Hypotension - Frequent swallowing **💊 3. Medications** - Injectable antibiotics and analgesics initially - On discharge: - Oral antibiotics for 7 days - Analgesic–anti-inflammatory syrup **🧴 4. Hydrogen Peroxide Gargles** - Diluted hydrogen peroxide gargles after every meal > What is the Mechanism of Action of Hydrogen Peroxide Gargles in post Tonsillectomy case? **🍽️ 5. Diet Advice** | Time | Diet | | --- | --- | | First 6 hours | Nil by mouth | | After 6 hours | Cold liquids | | Next 7–10 days | Soft, cold, non spicy diet | | Avoid | Hot drinks, acidic food, spicy food | | From 2nd week | Normal diet | 📌 Each feed should be followed by gargles --- ### 🔹 Normal Post Operative Findings The following **are normal and not alarming**: - Vomiting on operative day - Mild fever - Ear pain (referred otalgia) - Difficulty swallowing initially - White membrane over tonsillar bed - Temporary change in voice --- ### 📌 Exam & Viva Pearls - **Most common method**: Dissection and snare - **Position used**: Rose’s position - **Most important post-op danger sign**: Bleeding - **Hydrogen peroxide gargles**: Always mention mechanism --- 📚 **Next Part:** [Complications of Tonsillectomy](https://www.theentresident.com/ent-notes-lectures/tonsillectomy-complications.md) --- ## About This Note This free ENT note on Tonsillectomy Part 4 - Procedure & Post operative care 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-procedure-postop-care 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 - 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. Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md ## Medical-use Boundary The ENT Resident provides educational material for medical learning and revision. 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