Procedure

• Entire surgery through the mouth (no incision / no scar), opened wide with a mouth gag

• Visualise adenoids around the soft palate with a mirror or camera

• Scoop adenoids out or remove with coblation wand (low temperature radiofrequency)

• Dissect tonsils out and control bleeding with coblation wand or diathermy (electrical energy)

• Wash out any blood clots

Postoperative

• Moderate to severe pain and discomfort for a few days to 2weeks, especially in adults - the doctor will give pain medication (including a suppository if swallowing is painful and a throat spray). Please take medication regularly as prescribed to avoid pain rather than waiting for the pain to kick in - this is important for your child to eat and drink optimally

• Avoid strenuous activities for two days, but can play thereafter if up for it

• Small specks of blood in saliva or from nose is normal (if you see active ongoing bleeding, fresh red blood or large clots, contact Dr Du Toit immediately or go to the emergency department if after hours)

• Blocked nose and snoring is normal for the first few days due to swelling

• Ear and jaw or tooth pain because of referred pain from the nerves in the area

• Encourage lots of fluid intake like water, apple or grape juice or ice tea.  Fizzy sodas, especially Coke can be drunk if tolerated and will keep the tonsillar bed clean. Avoid acidic drinks like orange juice as this can burn and dairy products as they cause excess mucous production.  Ensure your child is not dehydrated (dry mouth and skin and sunken eyes)

• Soft foods on day one is acceptable (jelly, mash, pureed food), however chewing is encouraged and is very important from day two to promote healing. Ideal foods include toast with crusts cut off, biltong or droë wors, chips and salticrax. Salty foods help to keep the tonsillar bed clean.

• Chewing gum also helps to avoid stiffening of the jaw muscles and promotes healing. This can be given from day one

• Avoid hot, spicy or acidic food, such as curries, vinegar, tomatoes and most fruit except grapes and lichis

• There will be a whitish / yellow layer of slough where the tonsils were - this is a normal part of the healing process and not an infection. Expect a slightly bad breath with it

• A mild fever (37.5 - 38C) can develop after surgery, but if higher or it persists for more than 48 hours without responding to Paracetamol, please contact Dr Du Toit or visit you nearest emergency department

Possible complications

• Bleeding during the surgery will be controlled either by coblation, diathermy or sutures

• Bleeding in the first 24hours can be serious and patient might need to go back to theatre to control it

• Bleeding up to two weeks after surgery can happen due to infection lack of chewing / using muscles and can require admission and rarely theatre

• Secondary infection requiring antibiotics

• Neck pain from the positioning and rarely dislocation of cervical spine

• Injury to lips, tongue, palate or gums from mouth gag or instruments

• Apnoea (stopping breathing) once adenoids and tonsils are removed and anaesthesia reversed which might require high care or ICU to avoid fluid building up in the lungs

• Change in voice - either because blocked nose is now relieved or incomplete closure of soft palate after removal of adenoids

• Regurgitation of fluids or food through the nose due to incomplete closure of soft palate after removal of adenoids

• Regrowth of adenoids or tonsils

• Chronic pain in the throat area

• Anaesthetic risks

Follow up

• One week to assess healing and pain control