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PubMed2006

Cervical complications following routine tonsillectomy and adenoidectomy.

PURPOSE OF REVIEW: Fortunately, patients undergoing adenotonsillectomies have far more complaints than complications. Sore throats, dysphagia, and neck pain are frequent and expected symptoms after surgery. Differentiating these symptoms from early signs of severe cervical complications can be difficult. Such complications are rare but include atlanto-axial subluxation (Grisel's syndrome), cervical necrotizing fasciitis, cervical emphysema and cervical oseteomyelitis. Due to the frequency with which adenotonsillectomies are performed, most otolaryngologists will encounter these events during their career. This article is thereby intended to elucidate the early warnings, appropriate diagnostic workup, and therapeutic modalities for cervical complications following adenotonsillectomies. RECENT FINDINGS: Early recognition and intervention can prevent devastating morbidity and mortality described with cervical complications. Computed tomography scanning remains the gold standard for diagnosing cervical complications after adenotonsillectomy. Although a range of severity exists in cervical complications, most cases can be managed conservatively with broad spectrum antibiotics, observation, bedrest and immobilization in cases of Grisel's syndrome. Cervical necrotizing fasciitis requires a high index of suspicion and urgent management to avoid fatal consequences. SUMMARY: This is a review of the most frequently encountered, although rare, cervical complications following adenotonsillectomies. It gives the reader an insight into the efficient diagnosis and management of these complications.

Adenoidectomy↗
PubMed1979

Unilateral grommet insertion and adenoidectomy in bilateral secretory otitis media: preliminary report of the results in 91 children.

This study evaluates whether the use of grommets in the primary treatment really changes the course of secretory otitis media. The patient acts as his own control. Bilateral cases are selected and one ear is treated by a grommet, the other left intact, and all have their adenoids removed. Until now 91 children have been entered. A repeated operation was done in 13, and 6 of them had a contralateral grommet because of persisting middle ear effusion. A discharge occured from 25% of the operated ears. After the operation the intact ear showed a great improvement in the function of the Eustachian tube according to the tympanograms. The hearing level was normalized within 3 months in both intact and operated ears. In 28 children the grommets had been extruded for more than one month. By comparing the intact and the operated ears no significant statistical difference was found.

Adenoidectomy↗
PubMed1990

Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy.

Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.

Adenoidectomy↗
PubMed1978

Parental smoking related to adenoidectomy and tonsillectomy in children.

Histories of adenoïdectomy and tonsillectomy were ascertained, as well as smoking habits of both parents, using questionnaires answered by 3920 schoolchildren aged 10 to 20. Adenoïdectomy and/or tonsillectomy, considered as an index of repeated upper respiratory tract disease in early childhood, was very significantly related to the amount of smoking by each parent. This relationship persisted when age, sex, day nursery attendance, sibship size, and history of appendicectomy were controlled.

Adenoidectomy↗