Tonsillectomy and adenotonsillectomy: Post-operative care
After tonsillectomy, it is usually common to find a white slough inside the throat on either side where tonsils used to be present. When you examine your child and find such slough, then it is not to be worried about and should be considered as just a normal healing process. The slough may be seen for a few weeks following the surgery. Even the uvula (flap) – the tissue that is seen dangling at the back of the throat looks inflamed – swollen and bruised, which will settle down over a period of time. The other findings may include yellowish appearance of the inflamed area, which is surrounded by red edges with some smell – which is nothing to be worried about.
Earache and throat pain following tonsillectomy
Earache and throat pain may be experienced by the patient after tonsillectomy. Earache may be due to the pain brought up by the throat to the ears. Following tonsillectomy, particularly after the first three to four days, the throat pain may become worst and may be slightly severe for up to 10 days after the procedure – especially in adults, and then gradually settles down day by day.
Are antibiotics necessary following tonsillectomy?
The wonder drugs may or may not be prescribed following the surgery. However, in the past, the antibiotics were regularly prescribed for the patients in whom tonsils were removed. Normally a five days prescription may be given as a liquid or syrup for children and for adults tablets or capsules are prescribed. Even now for some patients antibiotics are prescribed, but according to the latest research studies, antibiotics are not routinely necessary for patients in whom tonsils or adenoids have been removed.
How to overcome pain following the removal of tonsils?
Pain associated with tonsils or the pain following the removal of tonsils can be alleviated or relieved by taking ibuprofen or paracetamol kind of medications including Diclomol, Crocin and ibuprofen. Follow the instructions of your doctor regarding the dosage and frequency of usage as these medicines are capable of causing potential damage to your liver in case of over dosages. In general paracetamol over dosage is very serious and may cause liver injury and liver failure as well. These medicines can even pose threat to your kidneys as well.
A soft diet is good following tonsillectomy and it is recommended for at least a week. During this time fluid intake is encouraged. The soft diet includes khichdi, Upma, Yoghurt, soft sandwiches, scrambled eggs, soft Idli, soft fruits, and ice cream. Salty, dried and sharp food stuff is not recommended and it should be avoided. Even the foods that require excessive chewing such as firm meat should also be avoided. Hot drinks are not permitted, but lukewarm beverages and drinks are permitted. Similarly, hard foods like dry chips, salty processed foods, and dry toasts should be avoided. Usage of honey which is warm, but not hot is helpful in soothing the inside of throat and back of the throat following the removal of tonsils. If the patient is a child, he or she should get enough fluids and calories during the early operative period – and if the child is tolerating soft ice cream, yoghurt and water following tonsillectomy, then it is fine as long as the child is meeting the fluid and calorific requirement.
Rinsing mouth and throat with warm water
It is not essential to rinse the mouth, but if you wish to do so simply use a teaspoonful of salt in a cup of boiling water and cool this until it is just warm – and then, use it to rinse the mouth.
Rarely a child may dehydrate because they refuse to drink enough following the surgery. Often they may tolerate an icy Pole and this is the first thing usually given to them after the surgery and could be tried. If you are concerned regarding a lack of fluid intake, let me know as very rarely a child may need to be readmitted to a hospital and placed on an intravenous drip.
Bleeding following Tonsillectomy
The risk of bleeding following tonsillectomy or adenoidectomy is there; therefore, for many patients it is something to be a major cause for concern. However, following the removal of adenoids the risk of bleeding is very low. There could be a possibility of small amount or streaks of blood with mucus – which should not be taken as seriously. But, if the patient spits blood, which is bright red and the quantity is somewhat more than usual and if this happens within or up to two weeks of surgery, then they must be taken to the nearest emergency department.
For up to a week after the removal of the tonsils,it is better for the patient to take rest at homeand to be at ease. After 2 weeks,vigorous activity such as sport can be commenced.
Adenoidectomy: Post-operative Care
For adenoidectomy alone there are no restrictions upon dietary intake.The risk of bleeding following the removal of adenoids alone is very small and generally children can be kept at home for up to three days, and then are allowed to go back to school, preschool or day-care. Occasionally, after the removal of adenoids, which is after 5 to 7 days of surgery, a child may develop a bad breath – which may persist for a few days. This is a part of the normal healing response and should not be of any particular concern for the parents.
Routinely I see patients one week after the removal of tonsils or adenoids; and usually, this appointment is arranged for the patient at the time of their discharge.
Post-operative care following Uvulopalatopharyngoplasty (UPPP)
Uvulopalatopharyngoplasty is a surgical procedure that involves the removal of excess tissue from the uvula and soft palate – the area in the back of the roof of the mouth. Uvula is a small pendant fleshy lobe that is hanging down from the back of the soft palate.
Meaning of Uvulopalatophayngoplasty – The termUvulo< refers to this structure; palato refers to palate and pharyngo to the pharynx. Plasty is a surgical procedure done for repairing, restoring and replacing a body part.
Purpose of Uvulopalatopharyngoplasty – The objective of this surgical procedure is to either reduce snoring or to improve the quality of sleep by treating obstruction.
Preparation for Uvulopalatopharyngoplasty (UPPP)
The person who has been recommended to undergo Uvulopalatopharyngoplasty will be advised by his or her doctor to restrain from taking any food or water after midnight and the day leading up to the surgery. However, the patient can as usual brush their teeth, but should not swallow water. If the patient is on medication that must be taken, then he or she should discuss about such medication with the doctor or anaesthesiologist and follow the instructions given by them. The procedure may not be recommended for the patients who have recently taken medicines or who are on medication that can hinder the normal blood clotting process – such medicines may include heparin, aspirin, blood thinners and anti-inflammatory medicines.
In this type of surgery, an instrument is placed between the upper teeth and the tongue to keep the tongue out of the way and to open the mouth wide and hold it in that position. Tonsils are removed if they are present and are separated from the muscles that cover andattach to them. After the removal of tonsils, the excess tissue from the soft palate is also removed. Electric cautery is employed to control bleeding. During this process that involves the use of electricity, blood vessels are blocked to stop bleeding. The open area is sutured and closed by using dissolvable sutures.
Following the procedure the patient must concentrate on a few things such as the food, fluids and medication. A regular dose of pain medication is important to alleviate pain and ensure smooth swallowing of food. Adequate fluid consumption is very essential and the patient must follow it as a routine. To know whether the patient is taking adequate fluid or not, it is better to observe the colour of urine – alight coloured urine indicates adequate fluid intake.
The next important aspect is food. The patient can resume >a soft food diet as and when he or she desires. The site where the surgery was performed appears white – which means the back of the throat. The place where tonsils and or uvula were used to be present shows the formation of scab that usually appears white. At this juncture, and until the throat resumes normal colour – hard food like snacks, chips and other such food items should be avoided. It is normal for a patient or child to take rest for at least a week; during the first week following the procedure, the patient may experience earache – which is considered as a normal healing process unless it is accompanied with hearing issues. Patients can resume normal activities after two weeks. If this operation is done to treat sleep apnoea, a 2–3 days stay may be required to monitor the oxygen level in the bloodstream.
The expected outcomes of Uvulopalatopharyngoplasty
The procedure will help in improving the quality of sleep and reducing snoring. The patient may feel better once the sleep quality improves. However, it is not the only procedure which is necessary for the condition.
The Possible Complications of Uvulopalatopharyngoplasty
The procedure is relatively safe – however, there might be some uncommon risks that are involved. A few of such factors we will discuss here and the rest at the time of consultation. Still if you have any concerns then you may ask those when you meet us. It is however always better that you should be aware of the possible outcomes that may include but are not limited to:
Anaesthesia complications:General anaesthesia may be associated with a very small risk and for a patient who has had a family history of problems associated with anaesthesia – the risk increases. The risks associated with anaesthesia can range from vomiting and nausea to rare life-threatening complications. Therefore, the patient undergoing the procedure should discuss with the anaesthesiologist if he or she has any questions or concerns regarding the use of anaesthetic.
There might be a possibility of bleeding within seven to ten days of the surgery – which would be a minor bleeding. If bleeding occurs you should inform your doctor or surgeon.
To stop bleeding, ice cubes are mixed with water placed in a cup and a teaspoonful of salt is added to this mixture. This mixture if used for gargling should stop the bleeding. If the bleeding does not stop, you will need to return to the hospital for evaluation and treatment.
Temporarily you may notice a feeling of fluid in the back of your nose while drinking. This should only be temporary. Notify your physician if this continues.