Snare Tonsillectomy

The patient is brought to main operating room and given general endotracheal anesthesia and placed supine. The oropharynx is exposed by retracting the tongue and endotracheal tube inferiorly and placing the retractor in suspension. One tonsil is grasped with a curved allis clamp, between the wire of the tonsil snare. With an adequate grasp and medial retraction, the snare wire is wrapped around the tonsil and squeezed to create a natural cleavage plane. The tonsillar fossa is then filled with packing. Lastly, the packing is removed and active Bleeding within the tonsillar fossa is controlled with minimal bipolar diathermy cauterization. The oropharynx is then irrigated with normal saline. The retractor is removed and the procedure is terminated.

Sleep-disordered breathing and tonsillar hypertrophy
Recurrent tonsillitis

Bleeding disorders (relative)

Bipolar cauterization
Curved allis forceps
Gauze
Slotted tongue depressor for suspension
Snare wire with pistol-grip
Suction

N/A

N/A

Anterior tonsillar pillar
Posterior tonsillar pillar

Hemorrhage
Dehydration
Pain

N/A

Elinder et al. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol. 2016 Aug;273(8):2249-56.
Tan et al. Control of Pain After Tonsillectomy in Children: A Review. JAMA Otolaryngol Head Neck Surg. 2017 Sep 1;143(9):937-942.
Rubenstein et al. Rethinking surgical technique and priorities for pediatric tonsillectomy. Am J Otolaryngol. 2017 Mar - Apr;38(2):233-236.
Francis et al. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2017 Mar;156(3):442-455.
Magdalena et al. Histological analysis of tonsillectomies: relationship with surgical technique, post-operative pain and haemorrhage. J Laryngol Otol. 2016 Dec;130(12):1142-1146.