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Article
Indication of Adult Tonsillectomy & Postoperative Complication According to Indications
دواعي استئصال اللوزتين عند البالغين والمضاعفات الحاصلة حسب دواعي العملية

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Abstract

Background: Tonsillectomy remains the most common surgical procedure in field of otolaryngology, and it has a wide range of techniques, indications and complications. Aim of the study: To determine the indications of adult tonsillectomy and the postoperative complications in relation to each indication.Patients and methods: A prospective study of 180 adult patients aged 18-70 years underwent tonsillectomy kept under close observation for analysis.Results: In the study, the most common indication of surgery was acute recurrent tonsillitis (74%), upper airway obstruction (11.1%), suspected neoplasm (8.8) and post-quinsy (5.5%) respectively. The incidence of complications varies according to the indication, patients underwent tonsillectomy for acute recurrent tonsillitis had increased incidence of postoperative bleeding and uvular edema, while patients underwent tonsillectomy for upper airway obstruction had increased incidence of prolonged hospitalization and dyspnea.Key words: Tonsillectomy, tonsillitis, adult tonsillectomy

الخلفية: عملية استئصال اللوزتين هي من أكثر العمليات شيوعاً في حقل جراحة الأنف والإذن والحنجرة، وتتعدد طرق إجراء هذه العملية ودواعيها ومضاعفاتها .أهداف الدراسة: تحديد دواعي استئصال اللوزتين عند البالغين وتحديد مضاعفات العملية ونسبتها لكل داع من دواعي العملية.المرضى وطرق العمل : دراسة تتابعيه أجريت ل 180 مريض تراوحت أعمارهم من 18 الى 70 سنه أجريت لهم عمليه استئصال اللوزتين وتمت مراقبتهم بدقه من أجل التحليل البحثي.النتائج : تبين من الدراسة ان أكثر دواعي العملية هو التهاب اللوزتين المتكرر (74%) تليها انسداد المجاري التنفسية العليا نتيجة تضخم اللوزتين (11,1%) تليها أورام اللوزتين (8,8%) ثم خراج اللوزتين (5,5%).نسبة حدوث المضاعفات تعتمد على دواعي العملية، تبين إن المرضى الذين أجريت العملية لهم بداعي التهاب اللوزتين المتكرر ووذمة اللهاة بينما المرضى الذين أجريت العملية لهم بداعي انسداد الملك التنفسي العلوي هم الاكثر عرضه للرقود المطول في المستشفى والضيق التنفسي.


Article
A comparative study between coblation and bipolar electrocautery tonsillectomy in children

Authors: Hemin Ibrahim Saeed --- Abdulkhaliq Emin --- Moyaser A. Yaseen --- Ammar M. Saleh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 1 Pages: 81-89
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Tonsillectomy with or without adenoidectomy is an operation done frequently in all otolaryngology departments all over the world. Many new surgical techniques found over the last few decades to decrease the morbidity of this surgery. This study aimed to compare intraoperative efficiency and postoperative recovery between coblation and bipolar electrocautery tonsillectomy. Methods: This prospective study was carried out on 60 patients that underwent tonsillectomy over six months from 1(st) August 2014 to 31(st) January 2015 in Rizgary Teaching Hospital, Erbil city. They patients equally divided into two groups; coblation tonsillectomy (30 patients) and bipolar electrocautery tonsillectomy (30 patients). Their age ranged between 2.5-12 years. The operative time and intraoperative blood loss were recorded for each patient and compared. The parents were given a pain diary to record the level of pain each morning for ten days. Also, they were asked to report any complication like bleeding.Results: There was no statistically significant difference in the mean operation time between the coblation group and bipolar electrocautery group (6.89 min vs. 7.83 min, P = 0.11). The mean intraoperative blood loss was statistically lower for the bipolar electrocautery group versus the coblation group (1.43 ml vs. 15.37 ml, P <0.001). There was a statistically significant difference in the daily pain scores between the two groups in which the coblation group was associated with lower mean pain score. No episodes of primary or secondary hemorrhage were recorded.Conclusion: Bipolar electrocautery tonsillectomy offers the same operative speed, less intraoperative blood loss, more postoperative pain scores when compared with coblation tonsillectomy.


Article
THE EFFECT OF DEXAMETHASONE ON POST TONSILLECTOMY MORBIDITIES IN CHILDREN

Authors: Raid Yaqoub Yousef --- Saffaa Khalaf Faleh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 2 Pages: 82-86
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract This study aimed to evaluate the effect of preoperative single dose of Dexamethasone on postoperative morbidities in children undergoing tonsillectomy. This is a prospective study considering 90 children with chronic tonsillitis who underwent tonsillectomy between June 2010 and December 2010 at the Department of Otolaryngology in Al-Diwaniah Teaching Hospital in Al-Diwaniah city, Iraq. Compared with placebo, Dexamethasone group have lower percentage of post tonsillectomy morbidities (pain, postoperative nausea & vomiting and uvular edema) but without statistical significant. In conclusion, there is no statistical beneficial effect of preoperative dexamethasone on the postoperative morbidities in children undergoing tonsillectomy.


Article
8- TONSILLECTOMY FOR THE TREATMENT OF HALITOSISY!

Authors: Zahra Kadum Saeed --- Ahmed M Al-Abbasi
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2008 Volume: 14 Issue: 1 Pages: 37-41
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to investigate the tonsils as an origin of halitosis and to assess the efficacy oftonsillectomy for the treatment of oral bad breath caused by chronic tonsillitis. After excludingdental, periodontal, sinonasal, oral, pulmonary, and gastroenterological diseases as the origin ofhalitosis, fourty-four patients with halitosis caused by chronic tonsillitis which proved by positiveFinkelstein's tonsil smelling test (pressing the tonsils and smelling the squeezed discharge),were included in the study. All patients were treated by tonsillectomy. Subjective and objectivepostoperative assessment was based on self-and-family report and clinical assessment.Patients were reviewed after 4 and 8 weeks postoperatively. Complete improvement of halitosisoccurred in 31 patients (70.4%) after 4 weeks, this value increased to 35 patients (79.5%) in thesecond review after 8 weeks. It is concluded that tonsillectomy is significantly effectiveprocedure for the treatment of halitosis caused by chronic tonsillitis.

Keywords

TONSILLECTOMY --- HALITOSIS


Article
The role of amoxicillin in preventing post-tonsillectomy complications
دور الأموكسيسيلين في منع مضاعفات ما بعد استئصال اللوزتين

Authors: Moyaser A. Yaseen --- Hassan H. Ameen
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2013 Volume: 17 Issue: 1 Pages: 280-285
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Tonsillectomy is defined as the surgical excision of the palatine tonsils. This single blind prospective study of (200) patients underwent tonsillectomy in Al- Rizgary Teaching Hospital-Erbil- Iraq from February 2006 through June 2006.The main aim of this study is to evaluate the effect of post-tonsillectomy amoxicillin in preventing infection and secondary haemorrhage. Methods: Our patient’s ages ranged from 2.5 years-55 years and were randomly divided postoperatively into two equal groups. The first group received amoxicillin antibiotic with analgesic paracetamol up to one week postoperatively. The second group received only paracetamol for one week. All tonsillectomy surgeries were done by cold knife dissection method. Results: In the first group no one developed complications neither postoperative infection nor secondary hemorrhage , whereas in the second group who received only paracetamol, 4 patients (4%) had features of infections post operatively with another 2 patients (2%) developed secondary hemorrhage controlled conservatively. Conclusion: The above results showed no significant effect of post-tonsillectomy antibiotic to prevent infection or delayed bleeding.


Article

Authors: Ammar Hadi Khammas --- Mohammed Radef Dawood --- Yaseen Adeeb Sakran**, --- Azad Mohammed Abdullah***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Issue: 1 Pages: 128-133
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated.OBJECTIVE:To compare intraoperative efficiency and postoperative recovery between dissection and coblation tonsillectomy. PATIENTS AND METHODS: This prospective clinical study was conducted at Rizgary teaching hospital/ Erbil,and Baghdad private hospitals from 29th November 2011 to 17th July 2012. The study included 100 patients who underwent tonsillectomy, half of them by coblation and the other half by cold dissection technique. Both techniques performed under general anesthesia. Each tonsillectomy technique was assessed intraoperatively for amount of blood loss, and duration of operation. Postoperatively they were assessed for pain, hemorrhage, and day of return to normal activity and normal diet.RESULTS: Duration of operations was significantly shorter for the coblation group versus the dissection group (17.7min vs. 22.3 min, P= 0.000). Intraoperative blood loss was statistically lower for the coblation versus the dissection group (45.3 ml vs. 74.7 ml, P = 0.003) There was statistically significant difference in daily pain scores and return to normal diet and activity between the two groups (mean 5.7 day for coblation vs. 7.32 day for the dissection, P= 0.001). And only two patients (4%) in coblation group developed secondary bleeding. CONCLUSION: Coblation tonsillectomy offers better operative speed, intraoperative hemostasis, less postoperative pain scores and faster recoveries than dissection tonsillectomy especially in pediatric age group.


Article
The Use Of Adjuvant Therapies For Tonsillectomy

Author: Hussein M. Hassan
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2006 Volume: 48 Issue: 4 Pages: 357-362
Publisher: Baghdad University جامعة بغداد

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Background: The aim was to ascertain the current practice of adjuvant therapy for tonsillectomy and to determine whether it is evidence based.
Methods: A questionnaire answers were obtained from sixty otolaryngologists in Baghdad.
Results: There was no any enthusiasm for routine intra-operative local anaesthesia.
Paracetamol (Acetaminophen) is prescribed by nearly all surgeons for postoperative analgesia, and the current literature supports its efficacy and safety.
Further, some practitioners combine paracetamol with NSAIDs, and/or Tramadol-Opioids. Evidence to support the additional use of these agents is, however non existent or limited.
For the use of antibiotics, we found some of the otolaryngologists do use a course of few days of pre-operative antibiotics and almost all of them do give postoperative antibiotics for seven-ten days.
Some aspects of tonsillectomy care are uniform and evidence based. Others are heterogenous and suffer from lack of adequate data in the literature.


Article
COMPARISON BETWEEN HYDROGEN PEROXIDE, ICED PACKS AND NON AGENT PACKS IN TONSILLECTOMY HAEMOSTSIS
مقارنة بين استعمال الشاش المنقوع ببيرو كسيد الهيدروجين ، بالسائل الملحي البارد و الشاش غير المنقوع في عملية استئصال اللوزتين

Authors: Dr .Mushtaq Nemaa د. مشتاق نعمة --- Dr. Moayad Naji Majeed د. مؤيد ناجي مجيد --- Dr .Ali Abid Saadoon Al –Guzi د. علي عبد سعدون
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2011 Volume: 5 Issue: 3 Pages: 8-15
Publisher: Thi-Qar University جامعة ذي قار

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ABSTRACT Objectives: Tonsillectomy is one of the operations most frequently performed by otolaryngologists, who are in search of a technique of tonsillectomy where the operation time and operative blood loss is reduced. This study was carried outto evaluate the effect of hydrogen peroxide 3% in comparison with iced normal saline on tonsillectomy times, blood loss during the surgery and on the number of packs used.Methods: Analytical cross sectional study was performed on thirty patients was carried out in the Department of Otolaryngology of AL-Habbobi General Hospital,AL-Nassyria, Iraq, in the period from the 1st week of March 2010 till the last week of November 2010. Tonsillectomy was performed using hydrogen peroxide 3% as a haemostatic agent in Group A(n = 15 tonsils), while in Group B (n = 15 tonsils) iced normal saline was used where as no agent was used with the gauze pack in GroupC(n=30 tonsils). Results: The application of pack socked with hydrogen peroxide 3% or iced saline in the tonsillar fossae reduced the operation time , the operative blood loss and also reduced the number of packs used in Group A and B in comparison with non agent method . The results were statistically significant. Conclusion: The local application of 3% hydrogen peroxide on the tonsillar bed after tonsillectomy is beneficial to decreasing the volume of blood loss more than other applications;while no significant difference between group A and B regarding the number of packs used and duration of operation

الخلاصة: عملية استئصال اللوزتين هي إحدى أكثر العمليات التي تجري من قبل جراحي الأنف والأذن والحنجرة اللذين يبحثون في الطرق التي تؤدي إلى اختصار وقت العملية وكمية خسارة الدم أثناء اجرائها0في هذه الدراسة كان الهدف هو أجراء مقارنة بين فائدة استعمال الشاش المنقوع ببيرو كسيد الهيدروجين 3%,مع الشاش المنقوع بالمحلول الملحي البارد في اختصار وقت العملية ,كمية الدم المفقود وعدد لفات الشاش المستخدم 0طريقة العمل : أجريت هذه الدراسة التحليلية المقطعية على ثلاثين مريضا"(60لوزة) في صالة عمليات الأنف ولأذن والحنجرة في مستشفى الحبوبي العام في الناصرية –العراق للفترة منذ الأسبوع الأول من شهر آذار 2011الى الأسبوع الأخير من شهر تشرين الثاني 2011 تم تقسيم اللوزات الى ثلاث مجاميع ,مجموعة أ(15 للوزة) ,مجموعة ب(15 لوزة) والمجموعة الثالثة ج(30 لوزة) 0استعمل للمجموعة الأولى الشاش المنقوع بمادة بيرو كسيد الأوكسجين 3% وللمجموعة الثانية الشاش المنقوع بالمحلول الملحي البارد في حين لم يستخدم أي محلول مع الشاش في المجموعة الثالثة0النتائج: أظهرت النتاج أن الوقت كان اقصر وكمية خسران الدم وعدد لفات الشاش اقل في المجموعة التي استخدم فيها بيرو كسيد الهيدروجين 3%0الاستنتاج: استعمال بيرو كسيد الهيدروجين 3% ذو فائدة واضحة في اختصار وقت العملية وتقليل كمية الدم المفقود وعدد لفات الشاش المستخدم أثناء عملية استئصال اللوزتين أكثر من المحلول البارد والذي هو أفضل بدوره من الشاش غير المنقوع


Article
Incidence of Hypertrophied Tonsils in Patients with Chronic Tonsillitis Selected for Tonsillectomy
نسبة حدوث تضخم اللوزتين في المرضى المصابين باللتهاب اللوزتين المزمن و الذين تم اختيارهم لاستئصال اللوزتين

Authors: Ammar Hadi Khammas د.عمار هادي خماس --- Ehab T. Yaseen د. ايهاب طه ياسين --- Jawad A B Thuhaibat د.جواد الذهيبات
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 2 Pages: 96-100
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: - The tonsil reaches its maximum size during the childhood, when it is more active, and gradually becomes smaller after puberty and diminishes considerably in size. The appearance of the tonsil, on examination of the throat, may give a misleading estimate of its size. Some tonsils appear to lie very much on the surface of the throat with only a shallow tonsillar fossa; Others are much more deeply buried in a deep tonsillar fossa, depending partly on its size but, probably more importantly, on the degree to which it is imbedded in to the tonsillar fossa. Aim of the study: - To show the proportion of hypertrophied tonsils in patients with chronic tonsillitis selected for tonsillectomy. Patients & Methods: - A Descriptive study was conducted within six months period (June 2005 – December 2005), in the E.N.T. department at Al-Yarmouk Teaching Hospital. A total of 50 patients were examined and a history of chronic sore throat and malodorous breath were recorded. Patients with obstructive sleep apnea, quinsy, recent acute tonsillitis or suspected malignancy were excluded. Tonsil size (Volume) was measured according pillars, and cervical lymphadenopathy was recorded.Results: - Hypertrophied tonsils occurred in (41%) of patients selected for tonsillectomy with chronic tonsillitis.Conclusions: - The clinical size (on inspection) of the tonsils is not always the real size (on Measurement) of them. The size of the tonsils clinically is of less importance as an indication for tonsillectomy. Key Words: - Tonsillitis, Tonsillectomy, Hypertrophied Tonsils

الملخص:-الخلفية:- اثناء فترة الطفولة تصل اللوزتان اقصى حجمهما حيث تكونان أكثر فعالية و بعد فترة البلوغ يبدأ حجمهما بالتضاؤل تدريجيا و بشكل ملحوظ . أن مظهر اللوزتين قد يعطي انطباعا خاطئا عن حجميهما الحقيقي عند معاينة و فحص البلعوم فبعضها تكون سطحية مع ضحالة حفرة اللوزة بينما بعضها الآخر قد تكون أكثر عمقا. يعود السبب في ذلك الى حجم اللوزة و درجة انغمارها في حفرتها. من وجهة النظر السريرية يعتقد ان سبب تضخم اللوزتين هو عملية فسيولوجية تشير الى تكاثر الخلايا اللمفاوية ( صنف ب ) بينما اضمحلال و انحسار اللوزتين يؤشر اضمحلال فعالية الخلايا المفاوية و بالتالي وهن العمليات المناعية . هدف الدراسة:- لبيان حدوث تضخم اللوزتين عند المرضى المصابين بالتهاب اللوزتين المزمن و الذين تم اجراء عملية استئصال اللوزتين لهم .المرضى و طرق العمل:- تم اجراء هذه الدراسة الوصفية خلال فترة ستة اشهر في مستشفى اليرموك التعليمي قسم الانف و الاذن و الحنجرة . وقد صممت لتحديد العلامات السريرية المهمة للمرضى المصابين بالتهاب اللوزتين المزمن . تم فحص 50 مريضا ادخلوا الى المستشفى لغرض استئصال اللوزتين بسسبب اصابتهم بالتهاب اللوزتين المزمن و تم تثبيت تاريخهم المرضي . استثني من هذه الدراسة المرضى المصابين بانقطاع النفس اثناء النوم ( البهر ) و خراج اللوزة و التهاب اللوزتين الحاد و حالات الاشتباه بالاورام السرطانية . تم تدوين تضخم الغدد اللمفاوية العنقية و احتقان العماد الامامي لللوزة و نفايات الخبايا اللوزية . واعتمادا على قاعدة ارخميدس و باستخدام انبوب زجاجي مدرج تم قياس حجم اللوزة . النتائج:- تبين حدوث تضخم اللوزتين في 41% من المرضى المصابين بالتهاب اللوزتين المزمن المشمولين بهذه الدراسة .الاستنتاجات:- أن حدوث تليف اللوزتين و عدم فعاليتهما يعزز دور العلاج الجراحي في حالة التهاب اللوزتين المزمن . حجم اللوزة التخميني ( عند المعاينة السريرية ) ليس هو بالضرورة حجمها الحقيقي دائما ويعزى ذلك الى :-1- الحجم النسبي لللوزة و البلعوم 2- درجة انغمار اللوزة في الحفرة اللوزية.


Article
Ligation versus Diathermy in Tonsillectomy Haemostasis
الربط مقابل الإنفاذ الحراري في إيقاف النزف لعملية استئصال اللوزتين

Authors: Saad Shammas د. سعد شماس --- Muhammad Al-Baldawi د. محمد البلداوي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2006 Volume: 19 Issue: 3 Pages: 275-279
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractObjectives: A comparative prospective study of 400 patients to evaluate the ligation and diathermy techniques as methods of haemostasis in tonsillectomy.Methods: Four hundred patients were divided into two equal groups, calculating the haemostasis time, primary and secondary haemorrhage in addition to pain in both the ligation and diathermy groups.Results: Ligation technique had a high incidence of primary haemorrhage (5%) and less postoperative pain, while diathermy had increased incidence of secondary haemorrhage (5.5%), and more pain but with 40% reduction of haemostasis time. Conclusion: It is recommended to use the conventional ligation method especially in teaching centers for its safety, easily done by the juniors and less intensity of pain.Key words: Tonsillectomy; Ligation; Diathermy

الملخص:لقد أجريت دراسة مقارنة مستقبلية مناصفة لأربعمائة مريض لتقييم تقنية الربط والإنفاذ الحراري (الكي الكهربائي) للسيطرة على النزف أثناء عملية استئصال اللوزتين.تقنية الربط تشمل أعلى نسبة للنزف الابتدائي (5%) مع اقل نسبة من الألم ، وبالمقابل الإنفاذ الحراري يمتلك أعلى نسبة من النزف الثانوي (5,5 %) مع اقل وقت للسيطرة على النزف (40 %).نوصي باتباع طريقة الربط التقليدية وخصوصاً في المراكز التدريبية بسبب سلامتها وسهولة أجراءها من قبل الأطباء الجدد وكذلك لقلة الآلام .

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