TONSILEKTOMI

Indikasi
1. In certain infectious diseases of the tonsils or
the peritonsillar space with recurrent
exacerbation.

– terjadi 7x atau lebih episode selama satu tahun

– terjadi 5x atau lebih episode tonsillitis selama 2 tahun berturut-
turut
– terjadi 3x atau lebih episode selama 3 tahun berturut-turut.
– Abses peritonsil yang tidak sembuh dengan antibiotika dan setelah
dilakukan aspirasi abses yang masih menyisakan banyak pus.
2. In airway obstruction due (e.g.) to
tonsillar hyperplasia,

– Gangguan Pernafasan saat tidur karena pembesaran

adenotonsillar. Pasien sering terbangun dari tidur karena kesulitan
bernafas.
– Sleep apnea dengan gejala mendengkur yang terjadi pada saat tiur
dilelap dan terjadi henti pernafasan sesaat. (di lain hal ditunjang
dengan faktor risiko dari penderita seperti obesitas atau
craniofacial malformations)
– Obstructive sleep apnea in childhood
Bilateral Adenoidal Hyperplasia
(Intraopertive Photograph)
3. If a malignant disease is suspected
(e.g : lymphoma but need histological
confirm)
Kontra Indikasi
– Gangguan Koagulopati
– Anemia
– Gangguan Pembekuan Darah (PT dan APTT)
– Polysomnography test negative (Sleep Disorder)
Evaluasi
– Saturasi Oksigen
– Perdarahan di Luka Operasi
– Gangguan Pernafasan (Snorring, Sleep Pause)
– Gangguan Indra Pengecap
Komplikasi
– Hemorrhage (anemia, – Disturbance of taste
transfusion, death) – Hypoglossal nerve injury
– Airway obstruction – Lingual nerve injury
(edema)
– Recurrent laryngeal nerve
– Aspiration injury
– Velopharyngeal – Meningitis
stenosis/insufficiency
– Pharyngeal abscess
– Emphysema,
– Grisel syndrome (a rare type of
pneumomediastinum,
torticollis)
pneumothorax
– Dental injury, dislocation of the
– Necrotizing fasciitis
jaw
Teknik Tonsilektomi
– Tonsillar dissection – Hemostatic techniques
– Non-Heat / Cold Generating – Non-Heat / Cold Generating
– Heat Generating – Heat Generating
Tonsillar dissection

– Non-Heat / Cold – Heat Generating

Generating – monopolar cauterizing needle
– bipolar forceps & scissor
– Scissors
– KTP/holmium laser
– Raspatory – CO2 laser

– Loop (also as a – suction coagulation (also as a disposable

instrument)
disposable instrument) – argon plasma

– Hydro-Jet (a disposable – Ultrasonic knife (also as a disposable instrument)

instrument) – Coblation
– Colorado microneedle (a disposable instrument)
– Microneedle (a disposable instrument)
Hemostatic techniques

– Non-Heat / Cold – Heat Generating

Generating – monopolar cauterizing needle

– suture ligature – bipolar forceps & scissor

– injection of local anesthetic with – KTP/holmium laser

epinephrine – CO2 laser
– Röder loop – suction coagulation (also as a disposable
instrument)
– oversewing of cottonoids
– argon plasma
– Transcervical ligation of the external
carotid artery and its branches – Ultrasonic knife (also as a disposable instrument)

– Embolization via interventional – Coblation

radiology – Colorado microneedle (a disposable instrument)
– Microneedle (a disposable instrument)