Complications of adenotonsillectomy

Current Opinion in Otolaryngology & Head & Neck Surgery:

December 2010 - Volume 18 - Issue 6 - p 539–543

doi: 10.1097/MOO.0b013e3283404dcc

Pediatric otolaryngology: Edited by Lisa Buckmiller

Statham, Melissa M

Abstract

Purpose of review: Tonsillectomy and adenoidectomy are two of the most commonly performed pediatric surgical procedures. As with all surgical intervention, tonsillectomy and adenoidectomy are associated with a host of potential complications. Fortunately, for most children undergoing adenotonsillectomy (T&A), complications are rare. This review is intended to summarize recent reports, which may lead to prevention and treatment of T&A complications.

Recent findings: The presented reports of complications and risk factors for complications in children undergoing T&A highlight perioperative medical management as a means to decrease perioperative complications. Certain tonsillectomy techniques, such as microdebrider intracapsular tonsillectomy, may lead to decreased posttonsillectomy hemorrhage and dehydration. Despite published recommendations, preoperative assessments for bleeding diatheses vary among practitioners. Conversely, guidelines for evaluation of posttonsillectomy hemorrhage are lacking. Some pediatric populations, such as children with coagulopathy, neurologic disease, and obesity, have increased risk of perioperative complications, and recent reports regarding their care are presented.

Summary: We present recent data pertinent to the contemporary management of medical and surgical complications of T&A, with particular focus on specific at-risk pediatric populations. In the patient groups illustrated in this review, anticipation of complications may decrease complications or lead to improved management of complications when they occur.

Posttonsillectomy hemorrhage: Blame on surgeons or genes?

The Laryngoscope

Volume 120, Issue 9, pages 1784–1787, September 201

1. Diana Arweiler-Harbeck MD, 
2. Ender Öztürk MD, 
3. Agnes Bankfalvi MD, PhD, 
4. Stephan Lang MD, PhD, 
5. Winfried Siffert MD, PhD,
6. Kurt Werner Schmid MD, PhD, 
7. Jürgen Peters MD, PhD, 
8. Michael Adamzik MD, PhD

Abstract

Objective:

To investigate whether the insertion/deletion polymorphism (−94ins/delATTG) in the promoter of NFκB1 is associated with the risk of bleeding after tonsillectomy.

Design and Setting:

Retrospective study with genotyping performed from tonsillar tissue or blood.

Patients:

One hundred forty-eight patients having undergone tonsillectomy due to chronic tonsillitis, with or without posttonsillectomy hemorrhage.

Measurements and Results:

DNA-extraction from paraffin-embedded tonsillectomy tissue or blood was followed by genotyping for the insertion/deletion (−94ins/delATTG) promoter NFκB1 polymorphism. Genotypes differed significantly between patients with (n = 56) and without (n = 92) posttonsillectomy hemorrhage, with the frequency of the homozygous deletion genotype carriers (DD) significantly increased in those with posttonsillectomy bleeding with an odds ratio (OR) for bleeding of 3.78 (95% confidence interval [CI] 1.2–11.7, P = .023) but not in homozygous (II) insertion and heterozygous (ID) genotype carriers (II/ID). Genotype distribution in patients was compatible with the Hardy Weinberg equilibrium. In contrast, there were no statistically significant differences between patients with or without posttonsillectomy hemorrhage with regard to demographic characteristics, different surgeons, postoperative medications like analgesics, antibiotics, anticoagulation therapy, or values of variables of pre- and postoperative coagulation studies. Likewise, these variables revealed no differences between genotypes.

Conclusions:

Carriers of the homozygous deletion allele were at an almost fourfold risk to develop posttonsillectomy hemorrhage compared to homozygous and heterozygous insertion allele carriers, independent of other risk factors. Laryngoscope, 2010