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Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
All patients presenting with confirmed cervical lymph node metastatic squamous cell carcinoma and no apparent primary site should undergo: Positron emission tomography-computed tomography whole-body scan.Panendoscopy and directed biopsies.Bilateral tonsillectomy.Tongue base mucosectomy can be offered if facilities and expertise exist.
Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
5.11. A child of 8 years has had a fever of 40°C (104°F) for 2 days. The tonsils are enlarged and inflamed and partly covered by a mucopurulent exudate. The cervical lymph nodes are enlarged and tender. Which of the following is/are true?A negative Paul-Bunnell test would exclude glandular fever.Hypertrophy of the lingual papillae and a confluent desquamating skin rash indicates haemolytic streptococcal infection.If streptococci are grown from the throat swab, tetracycline is the treatment of choice in patients with penicillin allergy.Palatal paralysis would indicate the need for immediate isolation.Tonsillectomy should be advised following recovery.
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
Intravenous or oral penicillin for 5 days is the treatment of choice in acute infections (erythromycin in cases of penicillin sensitivity). For beta-lactamase-resistant infections, amoxicillin–clavulanate may be necessary. Rehydration, antipyretic and analgesic therapy is required. Tonsillectomy is recommended for recurrent, chronic or complicated tonsillitis. Recurrent tonsillitis may justify tonsillectomy if there are seven or more episodes during a 1-year period, five per year over 2 years, or three per year for 3 years or longer (SIGN guideline 117).
Impact of tonsillectomy on COVID–19 pandemic: an observational study of the incidence and prognosis
Published in Acta Oto-Laryngologica, 2021
Ahmet Kara, Halil Elden, Engin Okur, Mahmut Sinan Yilmaz, Fuldem Mutlu, Mehmet Guven, Deniz Demir
The research protocol was submitted to and approved by the Sakarya University Ethics Committee (No: 12/03/2021 − 161) and was conducted in accordance with the ethical regulations of the Declaration of Helsinki and in adherence to law and regulations. Patients between the ages of 15 and 65 who had tonsillectomy operation in xxx University Faculty of Medicine, Otolaryngology Department (ORL) between January 2010 and January 2020 were designated as tonsillectomy group. The tonsillectomized pediatric group was excluded from the study, since Covid 19 symptoms were lower in the pediatric population who underwent tonsillectomy, and therefore rRT–PCR was performed less frequently than in this patient group. Individuals comparable to the study group for age and sex without a history of tonsillar pathology were selected as control group. Then, the presence of rRT–PCR tests for SARS–CoV–2 was investigated through the Public Health Management System of all participants, and cases with positive rRT–PCR test were recorded for statistical comparison.
Ibuprofen and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy: a systematic review and meta-analysis of randomized clinical trials.
Published in Expert Review of Clinical Pharmacology, 2021
Alessandro Simonini, Francesco Murgia, Marco Cascella, Franco Marinangeli, Alessandro Vittori, Maria Grazia Calevo
Tonsillectomy is the most common pediatric surgical procedure in the United States [1]. Its postoperative course can be characterized by significant pain requiring adequate analgesic therapy. In this context, opiates are often used although their use is burdened with adverse effects such as nausea, vomiting, excessive sedation, and respiratory depression. The most common indications for surgery are recurrent throat infections and Obstructive Sleep Apnea Syndrome (OSAS). Since one-third of OSAS persist even after surgery, the use of opiates is a potential cause of postoperative respiratory complications, even serious ones [2]. A well-known and potentially serious complication of tonsillectomy is intraoperative or postoperative bleeding. In the published reports, the rate of primary bleeding (in the first 24 hours after surgery) varies from 0.2% to 2.2%; the secondary bleeding rate (>24 hours after surgery) varies from 0.1% to 3% [3].
Parents’ management of adolescent patients’ postoperative pain after discharge: A qualitative study
Published in Canadian Journal of Pain, 2020
William Dagg, Paula Forgeron, Gail Macartney, Julie Chartrand
Much of the research on parental postoperative pain management focuses on the care provided by parents whose children underwent outpatient surgery (e.g., tonsillectomy, inguinal hernia repair, myringotomy tube insertion) and thus focuses on only a few postoperative days. Nevertheless, these studies indicate that postoperative pain management is a significant issue for parents in the home setting. Postoperative pain after day surgery can be both intense and long lasting in children, making it necessary for parents to be competent in pain management. In terms of duration of pain following day surgery, Wilson et al.10 examined the duration of pain in 251 patients from birth to 18 years of age undergoing head and neck surgery (e.g., adenoidectomy, myringoplasty, ankyloglossia) and found that their pain lasted on average 9 days postsurgery. In terms of pain intensity, Stanko et al.11 followed 100 children post-tonsillectomy to determine the incidence and intensity of pain on postoperative days 3 and 7 and found that tonsillectomy was associated with moderate to severe pain at home even into postoperative day 7. Furthermore, an integrative review of 51 articles on the pain management practices for patients undergoing tonsillectomy concluded that postoperative pain peaks on postoperative days 2 and 3 but can last up to 14 days.12 These findings suggest that parents of children undergoing inpatient surgeries may also need to manage pain once their child is discharged, because their child’s pain may both be intense and last for a significant period of time.