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.