Peritonsillar abscess – critical analysis of abscess tonsillectomy

Department of Otorhinolaryngology, Head and Neck Surgery, Philipps University of Marburg, Germany
Clinical Otolaryngology (Impact Factor: 2.39). 09/2003; 28(5):420 - 424. DOI: 10.1046/j.1365-2273.2003.00736.x

ABSTRACT The risk of secondary haemorrhage following abscess tonsillectomy is reported in the literature with differing rates. A retro- and prospective analysis of complication rates following abscess tonsillectomy was conducted in 142 patients (54 females, 88 males; mean age: 35 years). In 22% of patients, a secondary haemorrhage occurred. In half of these (11% of total), the haemorrhage had to be treated surgically. Secondary haemorrhage occurred most commonly on the 6th and 8th postoperative days. Reports in the literature are not in unison about the risk of secondary haemorrhage following abscess tonsillectomy and therefore allow no final judgement about an objective risk of this complication. This report strengthens the results of the ‘Comparative Audit Service’ analysis from 1997, which did show a high risk of secondary haemorrhage following tonsillectomy, as well as following abscess tonsillectomy.

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    ABSTRACT: Risk factors for postoperative haemorrhage after tonsillectomy are discussed controversy. In the past years surgical techniques were considered a determining factor for post-tonsillectomy bleedings in several studies.In a prospective, multicentre study 9 405 patients - of whom 4 437 underwent tonsillectomy and were focused in this article - were evaluated during study -period of 9 months (1st October 2009 till 30th June 2010). Postoperative haemorrhage was defined as any bleeding episode after extubation and classified according to a 7 grade scheme.Postoperative haemorrhage occurred in 14.4% (637/4 437) patients with 4.6% (204/4 437) requiring a return to theatre and 9.8% (433/4 437) experiencing minor bleedings. Bipolar techniques (with or without cold steel dissection) showed a haemorrhage risk of 16.8% (62/370). Severe bleedings occurred significantly more often with the use of bipolar techniques (8% compared to 4.6% severe bleedings for all operation techniques, p=0.003). In addition, Coblation® technique had a higher postoperative haemorrhage rate (23.5%, 12/51). However, minor bleedings occurred in the majority of patients operated with Coblation® technique (20% compared to 9.8% minor bleedings for all operation techniques, p<0.017).Following the strict definition of postoperative haemorrhage, we found higher postoperative haemorrhage rates for bipolar techniques and Coblation® technique. The proportion of severe bleedings is higher for bipolar methods, whereas the proportion of minor bleedings is higher for Coblation® technique.
    Laryngo-Rhino-Otologie 12/2012; · 0.82 Impact Factor
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    ABSTRACT: Objective To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. Patients and methods A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration,and therapeutic approach. Results Twenty-nine children were admitted, with a mean age of 7.4 _ 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8% had an upper respiratory infection and 65% were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillinclavulanate acid with clindamycin, including corticosteroids.Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6% of confirmed abscesses. The mean length of hospital stay was 5.6 _ 1.6 days. Delayed tonsillectomy was performed in 31%, except in one patient who developed a parapharyngeal abscess. Currently, 18.9% of all peritonsillar infections occur in the pediatric population. Conclusions The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of _-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed,is only indicated in patients with recurrent tonsillitis.
    Anales De Pediatria - AN PEDIATR. 01/2006; 65(1):37-43.