Removal of tonsils (tonsillectomy): consequences and complications

Postoperative complications of tonsillectomy (tonsillectomy) are divided into bleeding, infectious complications and a number of others.

Bleeding. In the overwhelming majority of cases, with the correct preoperative preparation of the patient and well-conducted surgical intervention, as well as in the absence of abnormally large vessels feeding the amygdala, the postoperative period passes without complications. However, under these conditions, tonsillectomized patients need special attention of the on-duty medical staff and, first of all, with regard to possible delayed bleeding. The operated patient should be warned not to swallow saliva and blood veins, but spit them into the towel provided to him, while he should not rub his lips roughly, but only apply a dry towel surface to them, otherwise the lips may develop herpetic rashes or inflammation of the mucous membrane. The patient after the operation should not sleep for at least the next 6 hours, and at night he should be visited by a nurse on duty 3-4 times per night and be convinced of the absence of bleeding.

It is especially important to comply with these rules for children who due to age characteristics can not follow the instructions of medical staff and if blood bleeding occurs during sleep, they swallow blood. Filling the stomach with blood causes the child to have a nausea that awakens him, and he has a sudden vomiting of blood, often in large quantities. The danger lies not only in massive blood loss, but also in blood aspiration during sleep and asphyxia. Having lost a significant amount of blood, the child becomes pale, sluggish, covered with cold sweat; the pulse is threadlike, heart sounds are weakened, blood pressure is lowered, breathing is frequent, superficial, pupils are dilated. The child has a strong sense of thirst. Significant loss of blood leads to a spontaneous cessation of bleeding, but the signs of hemorrhage noted above are harbingers of a shock from hemorrhage, which, if no appropriate emergency measures are taken, can lead to death. With significant blood loss, there may be a loss of consciousness, seizures, involuntary urination and defecation. These signs indicate an extremely serious condition. Large, especially rapid blood loss can lead to the development of acute vascular insufficiency. For a person, the loss of about 50% of blood is life-threatening, and a loss of more than 60% is absolutely fatal if there is no urgent intervention by resuscitators. In tonsillectomy (removal of the tonsils), one should keep in mind that the patient's serious condition can also occur with a much smaller amount of blood loss due to the fact that surgical intervention is carried out in a vast reflexogenic zone, whose trauma can lead to reflex spasm of the cerebral vessels, blood loss. In clinical practice, blood loss is assessed not only by the amount of blood lost, but also by the severity of the patient's condition. Death with blood loss occurs as a result of paralysis of the respiratory center. Rendering of emergency aid in blood loss is carried out by the reanimatologist, while the patient is assigned blood transfusion and blood-substituting fluids, agents that stimulate the functions of the respiratory and vasomotor centers, antishock drugs. When bleeding continues, hemostatic agents are prescribed (adroxone, antihemophilic globulin, vikasol, hemofobin, prothrombin complex, fibrinogen, etamzilate). Assign also vitamins C, K, B12, intravenous calcium chloride, etc. Among the hemostatic agents of local action, hemostatic sponges, fibrin isogenic film, adrenaline, etc. Can be recommended.

In rare cases, late bleeding may occur between the 5th and 8th days after surgery during the separation of crusts from the niches of the tonsils. As a rule, these bleedings are not dangerous and arise as a result of non-compliance with the sick diet.

Postoperative infectious complications occur much less frequently, but their appearance significantly complicates postoperative course, and in some cases presents a danger to life. Usually they occur in persons weakened by other infections, poorly prepared for surgical intervention, or if the postoperative mode of work and rest is not observed, and if superinfection (influenza, pneumonia, herpetic infection, etc.), not related to the operation, arises. Infectious complications are divided into local-regional, arising at a distance, and generalized.

Locally-regional complications:

1. postoperative angina or acute febrile pharyngitis, manifested by inflammation and hyperemia of the posterior pharyngeal wall, soft palate, regional lymphadenitis;
2. abscess of the lateral wall of the pharynx, which usually occurs on the third day after the operation; its occurrence can be caused by the introduction of a needle infection during passage of the infected amygdala surface, an imperfect surgical technique in which the lateral wall of the pharynx is injured with penetration into the muscle tissue or with an incomplete removal of the amygdala from the peritomaxial fossa;
3. postoperative diphtheria of the pharynx, especially in those cases when the operation was performed under unfavorable epidemic conditions.

In some cases, with simultaneous adenotomy, pyoinflammatory complications from the ears may occur.

Complications arising at a distance refer mainly to the bronchopulmonary system and are caused by the aspiration of blood and infected contents of the palatine tonsil (bronchopneumonia, lung abscesses, secondary pleurisies, etc.). Contribute to these complications are painful sensations in the pharynx and prolonged stay of tampons in niches of palatine tonsils, preventing active expectoration of blood and sputum from the bronchi.

Generalized complications include rare septicemia, which occurs 4-5 hours after surgery and is manifested by septic fever and severe chills. The process begins with thrombosis of the pharyngeal venous plexus, which extends to the jugular vein, and from there the infection enters the common bloodstream.

Sometimes after tonsillectomy (removal of the tonsils) hyperthermic syndrome, non-sugar transient diabetes, agranulocytosis, acetonemia develop. Cases of acute laryngeal edema occurring immediately after surgery and requiring an emergency tracheotomy are noted. In other cases, after tonsillectomy (removal of the tonsils), there is a rapid salivation, literally a spouting saliva from the anterior lower corner of the niche of the palatine tonsil, which is explained by the wounding of the anomalously located posterior pole of the submaxillary gland, which directly contacts the lower pole of the palatine tonsil. In these cases, appoint per os atropine and belladonna, which reduce drooling during the period of scarring of the damaged parenchyma of the salivary gland.

Other complications that sometimes occur after tonzillectomy (tonsillectomy) include subatrophic pharyngitis, cicatricial disfiguring of the soft palate and palatine arches that occurs with a savings-induced operation (individual predisposition to the formation of keloid scars), hyperplasia of the lymphoid formations of the posterior pharyngeal wall, and lingual tonsil , extending into the niche of the tonsil. In a number of cases, even with a normal postoperative picture of amygdala niches, some patients complain of paresthesia, pain in the pharynx, difficulty swallowing, unmotivated by any anatomical changes for many years after the operation. Special studies have found that these sensations are due to micronuroma arising when unavoidable ruptures of nerve endings of such nerves as lingopharyngeal, palatal and lingual. Treatment of patients suffering from these paresthesias, often provoking carcinogenesis, should be long, complex, using various physiotherapy methods, local balsamic applications and the therapist's curation.

[1], [2], [3]