Definition
Content
The supine position is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.
3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Absorbable biological suture material. Chromic is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Chromic is absorbed by enzymatic degradation. Note – catgut is no longer used in the UK for human surgery.
Incission: Coblation It is also other wise known as cold abalation. This technique utilises a field of plasma, or ionised sodium molecules, to ablate tissues. The heat generated varies from 40 - 80 degrees centigrade, much lower than that of electro cautery. The major advantage of this procedure is reduced bleeding and reduced post operative pain. Electrocautery Electrocauterization is the process of destroying tissue using heat conduction from a metal probe heated by electric current (much like a soldering iron). The procedure is used to stop bleeding from small vessels (larger vessels being ligated) or for cutting through soft tissue. Unlike electrocautery, electrosurgery is based on generation of heat inside tissue, using electric current passing through the tissue itself. Electrocauterization is preferable to chemical cauterization because chemicals can leach into neighbouring flesh and cauterize outside of the intended boundaries.[6] Ultrasonic coagulation and ablation systems are also available.
Harmonic scalpel tonsillectomy:
Harmonic scalpel is an ultra sound coagulator and dissector that uses ultra sonic vibrations to cut and coagulate tissues. The cutting operation is made possible by a sharp knife with a vibratory frequency of 55.5 KHz ovar a distance of 89 micro meters. Coagulation occurs due to transfer of vibratory energy to tissues. This breaks hydrogen bonds of proteins in tissues and generates heat from tissue friction. The temperature generated by harmonic scalpel is less than that of electro cautery hence it is safer (50 100 degrees centigrade as compared to that of 150 - 400 degrees centigrade). The major disadvantage is the expense of the equipment and the increased duration of surgery.
Bipolar Radiofrequency Ablation (see Coblation tonsillectomy): This procedure produces an ionized saline layer that disrupts molecular bonds without using heat. As the energy is transferred to the tissue, ionic dissociation occurs. This mechanism can be used to remove all or only part of the tonsil. It is done under general anesthesia in the operating room and can be used for enlarged tonsils and chronic or recurrent infections. This causes removal of tissue with a thermal effect of 45-85 °C. It has been claimed that this technique results in less pain, faster healing, and less post operative care [22]. However, review of 21 studies gives conflicting results about levels of pain, and its comparative safety has yet to be confirmed [23]. This technique has been criticized for a higher than expected rate of bleeding presumably due to the low temperature which may be insufficient to seal the divided blood vessels.
Tonsillitis Risk Factors: Risk factors for tonsillitis include:
• • • • • • • •
Alcohol use Splenectomy: o Removal of the spleen Exposure to someone with tonsillitis Sickle cell anemia Sinusitis Smoking Exposure to secondary smoke Any condition that weakens the immune system, such as: o Diabetes o Organ transplant o Chemotherapy
Predisposing Factors
Tonsillitis may be caused by viral or bacterial infection. The viruses causing tonsillitis are the same viruses causing the common cold (rhinovirus, parainfluenza and influenza virus, respiratory syncitial virus, adenovirus) as well as the Epstein-Barr Virus (EBV) which causes glandular fever. Bacterial tonsillitis is usually due to Group A beta-haemolytic streptococci.
Preexisting upper respiratory tract infection, Chronic (pre existing) tonsillitis, sinusitis, residual tissue after tonsillectomy, Immuno suppression, ingestion of cold floods / drinks. Infection from contagious person, foreign body etc.
Precipitating Factors
Factor, Precipitating; Factors, Precipitating; Precipitating Factor Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc.
Patho:
Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema, and pain. Rarely, the swelling may progress to the soft palate and uvula (uvulitis), or inferiorly to the region of supraglottis (supraglottitis).
3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Absorbable biological suture material. Chromic is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Chromic is absorbed by enzymatic degradation. Note – catgut is no longer used in the UK for human surgery.
Incission: Coblation It is also other wise known as cold abalation. This technique utilises a field of plasma, or ionised sodium molecules, to ablate tissues. The heat generated varies from 40 - 80 degrees centigrade, much lower than that of electro cautery. The major advantage of this procedure is reduced bleeding and reduced post operative pain. Electrocautery Electrocauterization is the process of destroying tissue using heat conduction from a metal probe heated by electric current (much like a soldering iron). The procedure is used to stop bleeding from small vessels (larger vessels being ligated) or for cutting through soft tissue. Unlike electrocautery, electrosurgery is based on generation of heat inside tissue, using electric current passing through the tissue itself. Electrocauterization is preferable to chemical cauterization because chemicals can leach into neighbouring flesh and cauterize outside of the intended boundaries.[6] Ultrasonic coagulation and ablation systems are also available.
Harmonic scalpel tonsillectomy:
Harmonic scalpel is an ultra sound coagulator and dissector that uses ultra sonic vibrations to cut and coagulate tissues. The cutting operation is made possible by a sharp knife with a vibratory frequency of 55.5 KHz ovar a distance of 89 micro meters. Coagulation occurs due to transfer of vibratory energy to tissues. This breaks hydrogen bonds of proteins in tissues and generates heat from tissue friction. The temperature generated by harmonic scalpel is less than that of electro cautery hence it is safer (50 100 degrees centigrade as compared to that of 150 - 400 degrees centigrade). The major disadvantage is the expense of the equipment and the increased duration of surgery.
Bipolar Radiofrequency Ablation (see Coblation tonsillectomy): This procedure produces an ionized saline layer that disrupts molecular bonds without using heat. As the energy is transferred to the tissue, ionic dissociation occurs. This mechanism can be used to remove all or only part of the tonsil. It is done under general anesthesia in the operating room and can be used for enlarged tonsils and chronic or recurrent infections. This causes removal of tissue with a thermal effect of 45-85 °C. It has been claimed that this technique results in less pain, faster healing, and less post operative care [22]. However, review of 21 studies gives conflicting results about levels of pain, and its comparative safety has yet to be confirmed [23]. This technique has been criticized for a higher than expected rate of bleeding presumably due to the low temperature which may be insufficient to seal the divided blood vessels.
Tonsillitis Risk Factors: Risk factors for tonsillitis include:
• • • • • • • •
Alcohol use Splenectomy: o Removal of the spleen Exposure to someone with tonsillitis Sickle cell anemia Sinusitis Smoking Exposure to secondary smoke Any condition that weakens the immune system, such as: o Diabetes o Organ transplant o Chemotherapy
Predisposing Factors
Tonsillitis may be caused by viral or bacterial infection. The viruses causing tonsillitis are the same viruses causing the common cold (rhinovirus, parainfluenza and influenza virus, respiratory syncitial virus, adenovirus) as well as the Epstein-Barr Virus (EBV) which causes glandular fever. Bacterial tonsillitis is usually due to Group A beta-haemolytic streptococci.
Preexisting upper respiratory tract infection, Chronic (pre existing) tonsillitis, sinusitis, residual tissue after tonsillectomy, Immuno suppression, ingestion of cold floods / drinks. Infection from contagious person, foreign body etc.
Precipitating Factors
Factor, Precipitating; Factors, Precipitating; Precipitating Factor Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc.
Patho:
Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema, and pain. Rarely, the swelling may progress to the soft palate and uvula (uvulitis), or inferiorly to the region of supraglottis (supraglottitis).
