The excision of the palantine tonsils, and if applicable, the removal of the nasopharyngeal tonsils (adenoids).
- Chronic tonsillitis associated with otitis media and nasal obstruction due to enlarged adenoid glands are indications for a tonsillectomy and adenoidectomy procedure.
- The adenoids are usually absent in patients over 15 years of age.
- In children, the procedure is relatively simple. The older patient, the more fibrosis there is and the more difficult the procedure, with a greater incidence of postoperative complications.
- Supine, arms may be extended on armboards or tucked at the patient’s side and restrained.
- The table is placed in slight Trendelenberg position. A rolled towel is placed under the shoulder to hyperextend the neck.
- Head or neck or basic pack with split sheet.
- Tonsillectomy and adenoidectomy tray
- Suction/ cautery with cord
- Bayonet coagulating forceps with cord.
- Basin set
- Tonsil sponges
- The surgeon will usually sit during the procedure.
- The mouth is retracted open with a self-retraining mouth gag, or a Davis model, which attaches to Mayo stand.
- The adenoids are removed first with an adenotome and/ or curette.
- A tonsil is grasped with a small tenaculum or tonsil-grasping forceps, and the mucosa is dissected free, preserving the posterior tonsil pillar.
- The capsule of the tonsil is separated from its bed.
- Suction should be immediately available.
- A tonsil snare is then looped over the tonsil and snapped over the pillar thus releasing the tonsil.
- The fossa may be packed with a tonsil sponge to aid in hemostasis.
- One or two plain catgut sutures may be placed over the tonsillar fossa.
- The procedure is repeated on the opposite side.
- An alternative method of hemostasis may be use of a combined suction-cautery unit.
- It is important to remember that the snare wire can only be used once, and is replaced for the removal of the other tonsil.
- The specimen should be separated, and one of the tonsils is tagged with a suture for identification.
Perioperative Nursing Considerations for Tonsillectomy and Adenoidectomy
- The suction tip and tubing are never dismantled until the patient is completely out of the room.
- The patient is placed on his or her side before being transported to the postanesthesia care unit.
- Have ties mounted on a tonsil clamp ready in advance.
- Sponges and needles are counted at routine intervals.