ABSTRACT
Tonsillectomy for enlarged tonsils has been so soundly criticized that doctors no longer date to suggest the operation. If they do come to the conclusion that the procedure in inevitable, it is only after an expensive and sometimes aggressive work-up. In order to better establish the criteria which should determine this indication for amygdalectomy, we studied a series of 47 patients undergoing this procedure for enlarged tonsils. We conclude that it is most important to base decisions on a thorough physical examination which includes careful inspection of the pharynx and a complete history. Particular attention must be paid to symptoms, especially nocturnal, and to the failure to gain weight.
Subject(s)
Palatine Tonsil/pathology , Pharyngeal Diseases/etiology , Tonsillectomy , Child , Child, Preschool , Dyspnea/etiology , Female , Humans , Hypertrophy , Infant , Male , Pharyngeal Diseases/surgery , Respiration , Retrospective Studies , Sleep Apnea Syndromes/etiology , Snoring/etiology , Surveys and QuestionnairesABSTRACT
The vascular complications of peritonsillar phlegmons have become exceptional. On the basis of a recent case, the authors sum up the criteria of severity, including: white puncture sample, paralysis of the 9th, 10th, 11th, 12th cranial nerves and of the cervical sympathetic nerve. Computed tomography allows not only refining the topographic diagnosis, but even sometimes diagnosing a pseudoaneurysm before it is fissured. At this stage, intraoperative radiology may probably prevent the unavoidable secondary rupture. If it cannot be used, preventive ligation must be proposed. In the absence of cataclysmic hemorrhage, this easier procedure usually does not cause any irreversible neurological deficit. If performed in emergency, it may entail a major risk, not only a neurological risk, but a vital risk as well.
