How I do it: control of post-tonsillectomy bleeding with the tonsil lolly.
Control of post-tonsillectomy hemorrhage--both arterial and venous--involves evacuation of the clot from the tonsillar fossa, tamponade of the bleeding site, and sometimes cauterization of the bleeding vessel. To expedite hemorrhage control, I have devised the tonsil lolly.
My tonsil lolly is easy to make: one needs only a plastic straw that has a spoon-like flange at one end and a small tonsil sponge. The string on the tonsil sponge is threaded through the straw, pulled tight, and taped around the shaft at the spoon end (figure). These combination straw-spoons are used in many casual restaurants for drinking milk shakes. They are made of relatively heavy-gauge plastic. I purchased a supply of these straws from the manager of a local restaurant, who obtained them from a wholesaler (Prairie Packaging; Bedford Park, Ill.).
To control post-tonsillectomy bleeding with the tonsil lolly, apply a topical anesthetic to the pharynx. Then use the spoon end, along with a Yankauer sucker, to dislodge and evacuate the clot. Moisten the sponge with oxymetazoline and place it into the tonsillar fossa. Apply and maintain light pressure by having the patient bite down on the straw for 20 minutes. Airway compromise is not a problem because tonsil sponges are available in small as well as large sizes.
Even if hemorrhage persists, its source is more easily located once the clot has been removed. The bleeding vessel can be cauterized with unipolar Bovie forceps after the area has been injected with a small amount of 1% lidocaine.
Some otolaryngologists believe every patient with a post-tonsillectomy bleed should be taken to the operating room. However, I have used this technique two or three times per year for 28 years (roughly 70 cases) without a single complication. (One teenager did have to be taken to the operating room for total anesthesia because he refused to open his mouth, but the tonsil lolly played no role in this incident.)
The primary advantage that the lolly has over a sponge on a hemostat is that patients are willing to bite down on a plastic straw, whereas most refuse to bite down on a metal hemostat. Thus, the patient can comfortably maintain pressure on the tonsillar fossa, freeing the surgeon for other tasks.
I am currently working with a manufacturer to produce a prepackaged, sterile tonsil lolly with a slightly sturdier straw and a sponge coated with a hemostatic agent.
From the Department of Otolaryngology--Head and Neck Surgery, University of Florida Medical School, Gainesville.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||SPECIAL TOPICS CLINIC|
|Author:||Parell, G. Joseph|
|Publication:||Ear, Nose and Throat Journal|
|Date:||Nov 1, 2006|
|Previous Article:||Nurse practitioners.|
|Next Article:||Middle ear injury through the external auditory canal: a review of 44 cases.|