Abscess Tonsillectomy in the treatment of Peritonsillar Abscess

Abstract

Clinica I for1111 I 56 1 vision; the extent of any oedema and its position can then be seen and infected material can be easily removed by suction from the oro-pharynx, where it tends to pool in a patient in the Trendelenburg position. There is a theoretical risk that a nasal tube on its way through the pharynx might rupture the abscess. Some anaesthetists have used oral tubes to obviate this risk, but it does not seem to be a problem in practice and the risk can be reduced if the nostril on the opposite side from the quinsy is used for the naso-tracheal tube when possible.Suxamethonium may be used with safety to faciliatate intubation if it is first ascertained that it is possible to inflate the patient manually.There are degrees of severity of quinsies and the individual anaesthetist must decide which is the most suitable method of induction for a particular patient in his hands but, in spite of the fact that forty-three patients were induced with a barbiturate and suxamethonium for intubation without complication in the present series, this should not be regarded as the method of choice. SutntnaryA review is presented of 114 cases of quinsy tonsillectomy. This shows that this advantageous operation has a low complication rate and is safe in skilled anaesthetic hands. and throat operations in infants 7. BENNETT, J.H. (1943) Anesthetic management for drainage of abscess of the submandibular space. and Laryngology, 68, 3 15. Respiration is one of the most affected physiological functions after thoracotomies. The main * This communication is based on a paper read at the 46th General Scientific Meeting of the Royal Australasian College of Surgeons held at Singapore in May 1973.

Peritonsillar abscessA retrospective study of medical treatment

“…The mean length of hospital stay in the present series of patients (6.9 ± 2.5 days) compares favourably with the hospital stay of patients treated by Quinsy-Tonsillectomy (6.8 Per Bonding, 1973;6.4 Beedon and Evans, 1970). One argument in favour of quinsy-tonsillectomy is that it reduces the total length of hospital stay, based on the assumption that peritonsillar abscess is an absolute indication for tonsillectomy and patients treated medically will require a further hospital admission for tonsil surgery (Bateman and Kodicek, 1954). It is worth recalling that quinsy-tonsillectomy and various other radical drainage procedures (Thacker-Neville, 1936) were initially employed before the availability of antibiotics.…”

“…Quinsy-tonsillectomy requires the administration of a general anaesthetic for which a skilled anaesthetist is required because of the risk of spontaneous rupture of the abscess during induction or intubation and subsequent inhalation of pus. There appears to be increased primary (operative) bleeding, compared with cold tonsillectomy (Bateman and Kodicek, 1954) and blood transfusion may be required (Per Bonding, 1973). The authors of one paper advocating quinsy-tonsillectomy, in preference to antibiotics and incision and drainage as the routine treatment for this condition, have expressed discomfort with the results of medical treatment of peritonsillar abscess (Yung and Cantrell, 1976).…”

XXIV Primary Quinsy Tonsillectomy

“…2 This was in a man already dying of a mediastinal extension of the abscess and occurred in spite of immediate drainage of his parapharyngeal, cervical and mediastinal abscesses rather than because of it. It is regarded as an argument in favor of early abscess tonsillectomy in order to pre vent such complications.…”

Tonsillectomy à chaud

“…Today there exist other conditions for performing tonsillectomy d chaud with regard to the method of operation, anaesthesia and treatment of infections. Bateman and Kodicek (1954), Grahne (1958) and Beeden and Evans (1970) have published optimistic results, of the use of tonsillectomy d chaud.…”