Clinical meaning
Tonsillectomy remains one of the most common surgical procedures in pediatric and adult otolaryngology. Indications include recurrent acute tonsillitis meeting Paradise criteria (≥7 episodes in 1 year, ≥5/year for 2 years, ≥3/year for 3 years), peritonsillar abscess, obstructive sleep-disordered breathing, and suspected malignancy. Surgical techniques include cold dissection, electrocautery, coblation, and intracapsular (partial) tonsillectomy. Post-operative hemorrhage is the most significant complication, occurring in 2-4% of cases. Post-operative hemorrhage is classified as primary (<24 hours, from inadequate surgical hemostasis) or secondary (5-10 days, from premature eschar separation). The clinician must perform pre-operative risk assessment, prescribe evidence-based perioperative protocols, manage post-operative analgesia according to current guidelines, and coordinate follow-up for complications.
Diagnosis & workup
Diagnostics & workup: - Order pre-operative CBC, PT/INR, and PTT (especially with bleeding history) - Review medication history for anticoagulants, NSAIDs, and herbal supplements affecting hemostasis - Order polysomnography for sleep-disordered breathing evaluation before surgery - Assess Mallampati score and airway anatomy pre-operatively - Evaluate pre-operative hemoglobin to establish baseline - Order type and screen if significant hemorrhage risk factors present - Post-operatively: CBC if hemorrhage suspected; monitor SpO2 continuously in OSA patients