Microdebrider-assisted tonsillectomy

Chapter 68 Microdebrider-assisted tonsillectomy


After general anesthesia is achieved, the patient is placed in the Rose position. According to surgeon preference the airway may be managed with a straight endotracheal tube, an oral RAE (Ring–Adair–Elwyn) tube or a laryngeal mask airway (LMA). The jaw is opened using a mouth gag, which can then be suspended. If concurrent adenoidectomy is to be performed, the soft palate is first inspected and palpated for the presence of a submucous cleft and then retracted using catheters that are placed through the nasal cavities and retrieved from the oropharynx. This maneuver also helps to stabilize the tonsillar pillars and pulls the uvula out of the surgical field.

With the microdebrider set at a rate of 1500 rpm on oscillating mode, dissection of the tonsil begins at the inferior pole (Fig. 68.1). This helps prevent blood from obscuring visualization of the anterior and posterior pillars. Dissection proceeds from a lateral to medial direction until the plane of the pillars is reached. At this point it is generally helpful to further stabilize and control the anterior pillar to maximize tissue removal and minimize injury to mucosa. A Hurd elevator is particularly helpful in this circumstance as it can also help to medialize the remaining tonsil tissue, making dissection easier. Dissection is carried down to but not through the capsule of the tonsil. The use of a mirror can facilitate dissection of the superior pole. Care is taken to avoid inadvertent injury to the uvula, which can occur rapidly given the suction associated with the microdebrider. After dissection is completed, hemostasis is achieved using suction cautery with settings generally between 20 and 40 watts according to surgeon preference (Fig. 68.2). The contralateral tonsil is then dissected in an identical fashion. Once the procedure is completed the pharynx is irrigated with sterile normal saline and the mouth gag is allowed to relax. After approximately one minute the gag is reopened and hemostasis is confirmed. A suction catheter is then passed under direct vision and the stomach and hypopharynx are suctioned free of any blood or irrigation fluid that may cause post-extubation laryngospasm.The mouth gag and nasal catheters (if present) are removed and the patient is turned over to anesthesia personnel for extubation.

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Jul 24, 2016 | Posted by in General Dentistry | Comments Off on Microdebrider-assisted tonsillectomy
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