EN4.39 | Tonsillectomy and Adenoidectomy — Summary & Reflection

KEY TAKEAWAYS

Tonsillectomy is indicated for recurrent tonsillitis meeting Paradise criteria (7/1yr, 5/2yr, 3/3yr), recurrent quinsy, obstructive sleep apnoea from tonsillar hypertrophy, and suspected tonsillar malignancy. Adenoidectomy is indicated for adenoid hypertrophy causing nasal obstruction, recurrent otitis media with effusion (especially before repeat grommet insertion), and recurrent adenoiditis. Absolute contraindication for adenoidectomy: cleft palate or submucous cleft (risk of VPI). The tonsillectomy procedure uses a Boyle-Davis mouth gag and proceeds by extracapsular dissection in the peritonsillar space between the tonsillar capsule and the superior constrictor. Haemostasis of the tonsillar vessels (especially the lower pole tonsillar branch of the facial artery) is the critical step. Adenoidectomy uses a St Clair Thompson's curette, curettage confined to the posterior and superior walls (not lateral — Eustachian tube orifices). Haemorrhage complications: primary and reactionary (within 24 hours — return to theatre), and secondary (5–10 days — most important to counsel about at discharge; any blood from the mouth = immediate hospital return). Grisel syndrome (atlantoaxial subluxation) and VPI are rare but important complications.

REFLECT

The hook scenario described a child with secondary haemorrhage on day 8, and parents asking whether to 'wait and see.' Reflect on what factors in a parent's mindset might lead them to underestimate the urgency of this situation — their child seems awake and talking, the bleeding has slowed, they are tired. How would you communicate the secondary haemorrhage warning at discharge in a way that cuts through these tendencies and ensures the message is genuinely understood? What role does written information (discharge instructions) play alongside verbal communication? Now consider the consent process for tonsillectomy in a child: how much of the risk discussion should be directed at the child (who may be frightened by talk of bleeding) vs the parents? What communication skills are needed to navigate this sensitively?