Post-tonsillectomy hemorrhage

Abstract

The most serious complication of tonsillectomy is bleeding. Primary post-tonsillectomy hemorrhage (PTH) occurs during the first 24 hours following the procedure, usually as a consequence of inadequate ligation of the feeding arteries. Secondary PTH occurs most frequently between the 5-8 postoperative days. Incidence of such episodes counts in several percent being an important clinical problem due to the number of tonsillectomies being very frequently performed ENT procedures. PTH occurs significantly more frequently in adults (age equal to or above 15 years) than in children. In children, the risk is higher in boys and in individuals with frequent infections of the tonsils. In adult patients, peritonsillar abscess as indication for surgery increases the risk of PTH. Bleeding occurs more frequently after "hot" than "cold" technique and the use of coblation significantly increases the occurrence of PTH. Cryptic tonsillitis and actinomyces infection diagnosed on histopathological examination of tonsillar tissue were found to correlate with PTH, whereas patient's gender and season of surgery were not. Performing tonsillectomy in warmer weather when water vapor pressure is higher may reduce secondary hemorrhage rate. Incidence of secondary PTH does not depend on post-operative infection. Post-tonsillectomy hemorrhage rate significantly correlates with personal history of pronen- ess to bruise formation and proneness to prolonged bleeding after minor injuries. In rare cases, the intensity of PTH may become life-threatening and requires major surgical means and intensive care. © 2011 Nova Science Publishers, Inc. All rights reserved.