Bar Ronen and Braverman Itzhak*
Otolaryngology Head and Neck Surgery, Hillel-Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, The Technion, Haifa, Israel
Received: 17 August, 2015; Accepted: 19 October, 2015; Published: 21 October, 2015
Braverman Itzhak, Assistant Professor and Chairman Otolaryngology Head & Neck Surgery, Hillel-Yaffe Medical Center, Hadera Israel. P.O.Box 169. Hadera 38100, Israel, Tel: 972-4-6188216; Fax: 972-4-6304885; E-mail:
Ronen B, Itzhak B (2015) The Risks of Haemostatic Materials in Tonsillectomy. Arch Otolaryngol Rhinol 1(2): 046-047. DOI: 10.17352/2455-1759.000008
© 2015 Ronen B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Tonsillectomy; Bleeding; Haemostatic Materials
Importance: Surgicel is an effective hemostat either for intra or post-operative bleedings, but should be used cautiously in the case of tonsillectomy. Some surgeons choose to leave pieces of surgicel in the tonsils bed for a continuous haemostatic effect. The material when left in the tonsils fossa is no different than other foreign body and put the patient in a significant risk of suffocation.
Observations: four years old girl was admitted to the E.R with multiple complaints and rapid deterioration of her physical state few days after tonsillectomy. Bulky Haemostatic Material spheres almost completely blocked the oropharynx. The foreign material was removed and the complaints resolved, with full recovery.
Conclusions and Relevance: leaving surgicel impactions in the oropharynx upon completion of tonsillectomy operation should be avoided.
Surgicel (Ethicon, USA) is a haemostatic agent made of an oxidized cellulose polymer, manufactured by Johnson and Johnson’s Ethicon subsidiary. It was first introduced into practice in 1947. Its main usage was to control intra-operative bleeding. For example, surgicel is widely used in oral and maxillofacial surgery in order to control intra-osseous hemorrhage .
A 4 year old girl was admitted to the E.R at Hillel Yaffe Medical Center with the complaints of fever, odynophagia, malaise, difficulty opening the mouth and muffled voice. The complaints started 4 days earlier, after tonsillectomy and adenoidectomy in another hospital. Upon physical examination the findings were signs of dehydration, muffled voice, and a refusal to open the mouth. When the child finally opened her mouth, we noted two round solid packing, one at each tonsil bed. The packing was removed and inspected thoroughly (Figure 1). The packing was a round condensed Surgicel, which was pre-formed by the surgeon to fit the size and shape of the tonsil beds. The surgeon put the material on both tonsil beds at the end of the surgery to create a prolonged haemostatic effect. The surgeon sutured the anterior and posterior pillars to apply local pressure and cease the ongoing oozing of blood on both sides. Unfortunately the partial dehiscence of the suture line exposed the foreign material, which was only partly anchored and bulged into the lumen on both sides. Thus put the child in a risk of aspiration and suffocation and contributed to the deterioration in her general condition. Rapid recovery was made once the Surgicel spherical foreign bodies were removed.
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