paients patients were placed in supine position with

paients
& method

study
design: A 
prospective  descriptive  study 
of  100 cases of tonsillectomy carried
out  in ENT center in Sulaimaniya
teaching hospital over a period of 8 months (jan .2017-aug. 2017). to compare
the two methods of securing the lower pole ,snaring & ligation regarding
the  post tonsillectomy complication

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Inclusion
criteria:

·       
patients of any
age

·       
chronic
tonsillitis

·       
sleep apnea
syndrome

exclusion
critria:

·       
adenoid
hypertrophy

·       
patients with
episode of acute tonsillitis

·       
parent refused
to participate

·       
patient with bad
follow up

·       
history of
cogulopathy diorder

·       
rhistory of
immunodeffecincy disorder

·       
orofasial anomaly
as submucous cleft palate.

·       
Chronic
systemic illnesses as DM, 
epilepsy, heart failur

·       
equinsy

·       
 tonsillar unilateral enlargement

·       
part of
palatoplasty

·       
upper &
lower respiratory tract infection

·      
Pregnancy
and lactation.

 

sampling:

convenient
sample of 100 patients of different ages ,complaining of chronic tonsillitis prepared
for tonsillectomy  was taken,  after dissection ,the tonsil on the right
side was removed by a snare ,but on the left side the lower pole secured by
ligation method

Data
collection:

the
data collected pre & postoperatively through direct interview with the patient
& there parents filling of  a special
quitionnae prepared for this study Each case after being screened from the
outpatient department of ENT center at Al 
Sulaimaniya teaching hospital the patients were addmitted one day before
the operation underwent history taking include demographic data,
otolaryngologic symptoms, past history, and family & drug history sp for
drugs as ibuprofen, aspirin, warfarin,  ENT, examination. All the patients investigated
to determine their fitness for general anaesthesia and the procedure.
Haemoglobin level, viral screening and coagulation profile was tested in all
the patients .Each patient or there parent signed an informed consent regarding
the operation, & the possible complications. next day the patient
transfered to operation  room underwent
tonsillectomy operation, the technique was uniform to all the patients of various
ages operated by the same surgeon using cold steel dissection. the procedure
done  under general anesthesia using
endotracheal intubation. The patients were placed in supine position with a
sand bag between the shoulders (Rose Position).The mouth was held open by a
Boyle’s Davis Gag supported by Draffin Bipod Stand. the tonsil was grasped with
the tonsil-seizing forceps and medially retracted gently the mucosa is then
incised using woods tonsil scissors Then the
peritonsillar loose areolar plane was identified
.the tonsil were dissected  using a
gwynne evans dissector until reaching the lower pole which is crushed using negus
tonsil artery forceps before being cut with the same pair of scissors mentioned
above. and silk ties were used to secure hemostasis . The fossa was packed with
cotton swabs .on the right side theme things done
but the  Inferior pedicle was snared with
Eve’s snare. On removal of gauze, bleeders if any  were secured by point coagulation or ligated. Suction was applied to nose and nasopharynx.
the mouth gag is then relaxed for 3 minutes, the orpharynx re-ecxpected for evidence
of bleeding & the procedure is terminated.

The
operative time was measured from the start of palatoglossal incision to the
attainment of hemostasis and was recorded separately for each side. The time
taken to operate on each side was recorded in minutes.

after
operation,the patients were taken to the recovery room, All the patients  were given  instruction about eating ice cream and cold fluids
& deit  during the 1st 24 hours then
shifting to warm fluid diet and back to normal diet gradually within three days
& received prophylactic antibiotic therapy in
the postoperative period for 7 days  and analgesics for 7 days

discharge
after recive advice for diet & AB,analgesia & planned for the schedule
of follow up

follow
up:

the
paiets were followed for posroperative complication through direct interview or
by cell phone for 4 periods, 1
st,2nd,7th,14th & after 1m asking about pain, fever,
& doing Full otolaryngologic examination
to detect evidence of infection in the tonsillar bed and the occurrence of post-tonsillectomy
bleeding & looking for the presence of tonsillar remnant. the patient or their
 family given instruction  to present to our emergency department if if
they had any comlication occured & call the researcher

Bleeding:
Each bleed was graded as

·       
false alarm (no
actual evidence of bleeding eg. vomited clots),

·       
Minor bleed as
blood-tinged sputum (no action needed apart from observation),

·       
Moderate bleed ,there
is Coagulum upon inspection (active non surgical intervention eg. drip, x
match, clot removal, I. V. antibiotics were needed)

·       
major bleed Bleeding
actively under examination (required exploration, blood transfusion).

Pain
The
patients were asked about  the intensity
of their postoperative pain for assessment by a graded index classified as:

·       
Mild- Pain with
swallowing alone.

·       
Moderate-Pain
with tongue movements and swallowing.

·       
Severe-Pain
present at rest, movement of tongue and Swallowing

tonsillar
remnant. During each visit particular attention was given to
smoothness of tonsillar fossa

the questionnaire
contain the following information:

-demographic
information ,name,age,sex,,addres

-preoperatine sign
& symptoms

fever,sorethoat,odenophyphagia,
dysphagia,otalgia,cough,trismus,enlarged tonsil, cervical LA

posttonsillectomy
complications: bleeding,pain,fever,tonsillar remnant

time
of op