T&A surgery

Pharynx location

begins at the internal nares and terminates posterior to the larynx at the level of the esophagus. anterior to the vertebrae in the midline of the neck

complications

bleeding, most common, can occur up to 10 days after surgery. post op SSI

Eustachian tubes

enter the nasopharynx, houses the pharyngeal tonsils

Surgical procedure step 13

final inspection of all sites performed and hemostasis verified

anesthesia for T&A

general for pediatric patients; local for adult patients

equiptment

headlamp 1/2 sheet x2 tonsil sponges no. 12 knife blade insulated esu suction cautery 8-fr robinson catheter

Surgical procedure step 11

hemostasis is achieved electrosurgically

preoperative diagnostic tests and procedures

history and physical exam

adenoiditis

inflammation of the pharyngeal tonsils. usually bacterial can be viral or from allergies. recurrent adenoiditis can lead to hypertrophy

oropharynx location

middle portion of the pharynx located posterior to the oral cavity, begins at the uvula, anterior opening is the mouth

nasopharynx location

most superior portion of the pharynx, located posterior to the nasal cavity.

Surgical procedure step 1

mouth is held open with a self-retaining mouth gag. tongue retracted w/ a Wieder tongue depressor. 8-fr robinson catheter may be inserted through the naso-oral cavity to retract the uvula from the operative site.

Pharynx lining

mucous membrane

Surgical procedure step 12

nasopharynx may be irrigated to be sure all clots and tissue have been removed

Pharynx regions

nasopharynx, oropharynx and laryngopharynx

skin prep for T&A

not required

Postop care

once extubated, patient should be put on side (prevents aspiration) elevate head of the bed slightly to reduce postoperative swelling. provide cold fluids to aid in comfort and prevent swelling. transport to PACU

Surgical procedure step 5

once the tonsil is amputated, pressure may be applied to the fossa with a tonsil sponge for a few minutes

draping for T&A

one or two 1/2 or 3/4 sterile sheets placed on patient. with adult patients the surgeon will wrap two turban's around the patients head with a perforating towel clip to isolate the hair. pediatric patients the hair will be isolated w/ a hair cover.

palatine and lingual tonsil location

oropharynx

lingual tonsils

pair of lymphoid areas located on the posterior surface of the tongue near the base

structures removed during tonsillectomy and adenoidectomy

palatine tonsils and adenoids

prognosis

patient expected to return to normal activities in 2 weeks. incidence of sore throats and infections should be reduced

adenoids

pharyngeal tonsils enlarged

Surgical procedure step 10

pressure is applied to control bleeding. PC: provide tonsil sponge loaded on a long instrument.

Surgical procedure step 7

procedure is repeated contralaterally. PC: surgeon generally does not switch sides. ST will reorganize supplies

pharyngeal tonsils function

provide protection against pathogen entering the nose.

peritonsillar abscess

results from failed antibiotic therapy/chronic tonsillitis. forms b/w tonsil and fascia covering the pharyngeal constrictor muscle.

Surgical procedure step 14

retractors removed

pharyngeal tonsils

single mass of lymphatic tissue embedded in the mucous membrane of the posterior wall of the nasopharynx.

position for T&A

supine with neck hyperextended for pediatric patients, sitting position for adult patients

practical considerations (order)

surgeon preference will dictate the order of the procedure. in a combo procedure some surgeons prefer to perform the tonsillectomy first and then the adenoidectomy.

palatine tonsil anatomy

2 oval masses of lymphoid tissue commonly called "tonsils" each has an anterior and posterior pillar.

wound classification

Class 11: cleancontaminated

Surgical procedure step 6

Hemostasis is achieved

Tonsillectomy and adenoidectomy (knowledge)

Tonsillectomy and adenoidectomy is the removal of the palatine, pharyngeal and laryngeal tonsils. Due to adenoiditis & peritonsillar abscess.

tonsillitis

acute or chronic, often caused by streptococcal organism. inflammation of the tonsils and their crypts.

Surgical procedure step 9

adenoids are removed w/ an adenotome or curette

7 years old

age lympathatic tissues of the tonsils usually starts to shrink.

practical considerations (surgeon)

the surgeon may stand at the patient's side or sit at the head of the table. make the necessary equipment adjustments and arrange the OR accordingly.

Surgical procedure step 4

the tonsil may be amputated with a snare or a guillotine, or electrosurgically removed from its fossa

Surgical procedure step 3

tonsil is dissected free of its mucosa

Surgical procedure step 2

tonsil is grasped and the mucosa of the anterior pillar is incised

Pharynx anatomy

tubular structure that serves the respiratory tract by receiving air from the nose and mouth, and the digestive system as a passageway for food and liquids

carbon dioxide laser

used to perform lingual tonsillectomy

Surgical procedure step 8

uvula is retracted to expose nasopharynx.