I've been fascinated by the case of Jahi McMath, who is the girl who suffered surgical complications after a tonsillectomy and has been left brain dead. I'll be discussing other aspects of this case next week but I thought I'd invite fellow medical musketeer and ENT physician, Dr. Richard Mabry, by to discuss the risks/benefits of this procedure.
Welcome back, Richard!
Any resident physician in otolaryngology (ear, nose and
throat) can tell you that tonsillectomy is not a benign procedure. It’s very useful
when indicated, but strict
criteria for its consideration have been developed. These include recurrent documented infections
as well as sleep-disordered breathing. Attention to these criteria is important
before tonsillectomy is considered.
Prior to the procedure, parents should feel free to ask
questions or seek clarification of any points they don’t understand. Most
physicians have instruction
sheets that are given to help prepare families for the procedure.
The procedure itself is typically short—30 to 60
minutes—after which the child is observed in the recovery room until they are
fully awake and stable. The child may be discharged later that day if they’re
doing well, but sometimes complications necessitate an overnight stay.
The risk associated with a general anesthetic administered
by competent personnel is tiny. Probably equally or more important is the possibility
of complications occurring after the procedure.
Undoubtedly, the number one
risk is post-operative bleeding. If the child expectorates clots or large
amounts of bright blood, parents should seek medical attention immediately.
They are also warned to watch for and report fever, persistent vomiting, or
difficulty breathing.
The tonsils receive their blood supply from branches of five
different arteries, so bleeding—at surgery and afterward—can be a problem. To
deal with this possibility, various methods—primarily application of caustic
chemicals, use of ligatures, or various types of cauterization—have been
traditionally been used. In recent years, surgical methods other
than sharp dissection have become more popular. These include partial
tonsillectomy and use of lasers to remove tonsil tissue. Thus far, the perfect
solution hasn’t been found.
What are the risks associated with tonsillectomy? According
to a recent
journal article, the risk of dying from the operation ranges from 1 in
10,000 to 1 in 35,000 cases. Although mortality (i.e., dying) is rare,
morbidity (i.e., complications) still occur. The most important, of course, is
bleeding after the surgery. In one study, the incidence of bleeding was reported at from 2%
to 3% of cases. The two most common times for post-tonsillectomy bleeding to
occur are immediately after the surgery and after about a week, when scabs
separate.
Does that mean that all parents should shy away from a
tonsillectomy for their child? Not at all. It’s a very beneficial procedure
when indicated and performed by a competent physician. But it behooves every
parent to ask questions, learn what to watch for, and participate in the care
of their child while they recover from the surgery.
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Richard Mabry is a retired physician, past Vice President of
the American Christian Fiction Writers, and author of “medical suspense with
heart.” His novels have been a semifinalist for International Thriller Writers’
debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice
Award, and winner of the Selah Award. You can follow Richard on his blog, on Twitter, and his Facebook fan page.
