T&a Complications.docx

POSTOPERATIVE CARE: 

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Pharyngeal pain from the surgical site and endotracheal intubation typically only requires nonnarcotic analgesics, such as acetaminophen or ibuprofen, on an as-needed basis. A minority of patients may also have neck pain that may last for several days to a few weeks. Occasionally a child will complain of ear pain after surgery. The ear pain is referred from the pharynx and is treated with over-the-counter pain medications. Many children will have significant halitosis that can last up to two weeks after surgery. The bad breath is a normal side effect of the surgery and resolves spontaneously. There are no dietary restrictions following adenoidectomy and most children consume a normal diet within zero to two days following surgery.

COMPLICATIONS: 

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Significant complications after adenoidectomy are uncommon in children. Postoperative hemorrhage almost always occurs in the first 24 hours following surgery rather than later. Velopharyngeal insufficiency (VPI), nasopharyngeal stenosis, and atlantoaxial rotary subluxation are other rare potential complications of the surgery. Occasionally the adenoids regrow due to incomplete removal. Repeat adenoidectomy may be warranted if regrowth is significant enough to cause recurrence of symptoms. Very rarely, meningitis, cervical osteomyelitis, or brainstem injury may complicate adenoidectomy. Postoperative hemorrhage — Postoperative hemorrhage following tonsillectomy can be classified as either primary/early (within 24 hours of surgery) or secondary/delayed (greater than 24 hours after surgery). Primary hemorrhage incidence typically ranges from 0.2 to 2.2 percent and secondary hemorrhage between 0.1 and 3 percent. Secondary hemorrhage most commonly occurs 5 to 10 days postoperatively and is caused by premature separation of the eschar, which may be precipitated by an underlying infection or dehydration. Postoperative hemorrhages usually stop spontaneously, but they sometimes require a return to the operating room for hemorrhage control. They seldom require blood transfusion. In rare cases, they can be life threatening. Children who have experienced a bleeding episode should be hospitalized overnight for observation. Velopharyngeal insufficiency — VPI is characterized by hyper-nasal speech, nasal air emission, and nasal regurgitation of fluids in severe cases. It is a known complication of adenoidectomy with an estimated incidence of approximately 1 in 1200 to 1 in 1500 procedures. VPI is most commonly thought to occur due to the unmasking of a pre-existing palatal problem, such as a submucous or occult cleft palate. Removal of the adenoids increases the size of the nasopharyngeal airway. The poorly functioning palate is no longer able to achieve nasopharyngeal closure with the adenoid tissue removed. Often VPI is temporary and resolves within a few weeks of adenoidectomy surgery. If hypernasality persists three months after adenoidectomy, further evaluation by a speech pathologist is indicated. Temporomandibular joint dysfunction — A mouth gag is used to keep the mouth open during the tonsillectomy/adenoidectomy. Rarely, this may cause dysfunction of the temporomandibular joint. Reduced mouth opening is not a common problem following surgery Nasopharyngeal stenosis — A rare complication after pharyngeal surgery is nasopharyngeal stenosis. This entity is characterized by significant narrowing or obliteration of the normal passage between the oropharynx and nasopharynx. Patients present with difficulty breathing through their nose, difficulty blowing air out their nose, hypo-nasal speech, and dysphagia. Obstructive sleep apnea (OSA), chronic rhinorrhea, and anosmia may occur if the stenosis is severe. Surgical correction is required for severe stenosis. Atlantoaxial rotary subluxation (Grisel syndrome) — Grisel syndrome is defined as nontraumatic subluxation of the atlantoaxial joint is a rare complication that can occur after adenoidectomy or other otolaryngologic procedures (tonsillectomy, mastoidectomy). Key features include severe neck pain accompanied by torticollis and pain upon head rotation