Tonsillectomy

Why are we operating?

Removal of the palatine tonsils from their fossae, high-volume, deceptively routine, and owner of one of surgery's most feared small complications: the post-tonsillectomy bleed.

Indication: Recurrent tonsillitis meeting frequency criteria, obstructive sleep apnoea in children, suspected malignancy, and quinsy that recurs.

The operation in 4 steps

1. 01Positioning and exposure

   Under a shared airway with the tube fixed midline, the mouth is held open with a gag, the tonsil grasped and drawn medially to display its fold.

2. 02Finding the capsule plane

   The mucosa of the anterior pillar is incised and the avascular plane between the tonsil capsule and the pharyngeal muscle bed developed from upper pole downward.

3. 03Delivery and haemostasis

   The tonsil is freed to its lower pole pedicle and delivered; the fossa is packed, then each bleeding point tied or precisely bipolar-coagulated until bone dry.

4. 04Recovery and counselling

   The bed is re-inspected before waking, and the family counselled: pain peaks around day 5, eating protects, and any bleeding at home, however small, returns to hospital immediately.

Danger zones

• Internal carotid artery

  Deep or lateral diathermy and deep suture bites pass toward it through a wall the operator cannot see beyond.

Anatomy you need

The mouth and pharynx: the tonsils sit in the lateral wall you see, with the internal carotid closer behind than anyone likes.

What can go wrong

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.