patients& methodstudydesign: A prospective descriptive study of 100 cases of tonsillectomy carriedout in ENT center in Sulaimaniyahteaching hospital over a period of 8 months (Jan .
2017-Aug. 2017). to comparethe two methods of securing the lower pole ,snaring & ligation regardingthe post tonsillectomy complication Inclusioncriteria:· patients of anyage· chronictonsillitis· sleep apneasyndromeexclusioncritria: · adenoidhypertrophy· patients withepisode of acute tonsillitis· quinsy· upper &lower respiratory tract infection· parent refusedto participate· patient with badfollow up· history of coogulopathydisorder· history of immunodeficiencydisorder· orofasial anomalyas submucous cleft palate.· Chronicsystemic illnesses as DM, epilepsy, heart failure· tonsillar unilateralenlargement· procedure partof palatoplasty· Pregnancyand lactation.
sampling:convenientsample of 100 patients of different ages ,complaining of chronic tonsillitis preparedfor tonsillectomy was taken, after dissection ,the tonsil on the rightside was removed by a snare ,but on the left side the lower pole secured byligation methodDatacollection: thedata collected pre & postoperatively directly from the patient or their parents filling of thequitionnaire of this study. Each case after being screened from the outpatientdepartment & by ENT specialists ofENT center at Al Sulaimaniya teachinghospital the patients were addmitted one day before the operation underwent historytaking include demographic data, otolaryngologic symptoms, past history, and family& drug history sp for drugs as ibuprofen, aspirin, warfarin, ENT, examination. All the patients investigatedto determine their fitness for general anaesthesia and the procedure.
Haemoglobin level, viral screening and coagulation profile was tested in allthe patients .Each patient or their parent signed an informed consent regardingthe operation, & the possible complications. next day the patient transferredto operation room underwenttonsillectomy operation, the technique was uniform to all the patients of variousages operated by the same surgeon using cold steel dissection.
the proceduredone under general anesthesia usingendotracheal intubation. The patients were placed in supine position with asand bag under the shoulders (RosePosition).The mouth was held open by a Boyle’s Davis Gag supported by DraffinBipod Stand. the tonsil was grasped with the Dennis Browne tonsil holdingforceps and retracted medially ,the mucosa is then incised using tonsil scissors Thenthe peritonsillar loose areolar plane wasidentified .the tonsil were dissected using a gwynne evans dissector until reaching the lower pole which iscrushed using negus tonsil artery forceps before being cut with the same tonsilscissors . and silk ties were used to secure hemostasis .
The fossa was packedwith cotton swabs on the right side theme thingsdone but the Inferior pedicle was snaredwith Eve’s snare. bleeders were secured by diathermy or ligated. the mouth gag is then relaxed for 3 minutes,the orpharynx re-ecxpected for evidence of bleeding & the procedure isterminated. Theoperative time was measured from the start of palatoglossal incision to theattainment of hemostasis and was recorded separately for each side.
The timetaken to operate on each side was recorded in minutes.afteroperation,the patients were taken to the recovery room, All the patients dischargeafter recive instructions about eating ice cream and cold fluids& deit during the 1st 24 hours thenshifting to warm fluid diet and back to normal diet gradually within three days& received analgesics & prophylacticantibiotic therapy in the postoperative period for 7 days.followup:thepaiets were followed for postoperative complication through direct interview orby cell phone for 4 periods, 1st, 7th,14th & after 1m asking about pain, fever,& doing otolaryngologic examination todetect evidence of infection in the tonsillar bed and the occurrence of post-tonsillectomybleeding & looking for the presence of tonsillar remnant. the patient or their family given instruction to present to our emergency department if ifthey had any comlication occured & call the researcherBleeding:Each bleed was graded as· Minor bleed asblood-tinged sputum ,no action needed apart from observation.
· Moderate bleed ,thereis blood clot on inspection, nonsurgical intervention, I.V fluid, clot removal, I.V. antibiotics . · major bleed :bleedingactively under examination (required exploration, blood transfusion). PainThepatients were asked about the intensityof their postoperative pain for assessment as: mild , moderate, severe tonsillarremnant.
During follow up,examination done looking for smoothness of tonsillar fossathe questionnairecontain the following information:-demographicinformation: name, age, sex,, address-preoperative sign& symptoms: fever, sorethoat, odenophyphagia, dysphagia, otalgia, cough, trismus, enlargedtonsil, cervical LA-time of operationposttonsillectomycomplications: bleeding, pain, fever, tonsillar remnant