Postoperative Care: Tonsillectomy & UPPP

Tonsils are lymphoid tissue at the back of the throat, one on each side. They’re usually removed because of recurrent infections (tonsillitis) or obstruction causing snoring and obstructive sleep apnoea. UPPP (uvulopalatopharyngoplasty) is an additional procedure done in the adult population for sleep apnoea. UPPP involves tonsillectomy and also the shortening and pulling outwards of the soft palate and muscles of the throat.

There are essentially 3 important things to know after a tonsillectomy/UPPP:

1. Pain. Tonsillectomy and UPPP is an uncomfortable procedure. Lots of pain relief will be given during and after procedure. Pain is usually worst around day 3 after surgery. Pain may include sore throat and earaches. The standard pain relief given will include regular paracetamol and celecoxib for the first 5 days. If formulations of celecoxib is not available, then ibuprofen/nurofen is an alternative. Tramadol and/or morphine based analgesics may also be given if there is a need for it. Strong analgesics in the paediatric population might be avoided as it may interfere with their breathing after surgery. DO NOT have any codeine (interferes with breathing), or aspirin (may cause bleeding).

2. Bleeding. The risk of bleeding is 1 in 20 in the first 2 weeks. Dark clots on the day of and the day after surgery is acceptable. Secondary bleeds often occur around day 5-10. If a small amount of bright red blood is noted (less than a teaspoon), encourage sucking on ice or sipping cold drinks. If there’s more significant amounts of bright blood noted, it is recommended that the patient attend the nearest emergency department or that an ambulance be called.

3. Diet. The patient is encouraged to return to normal diet as soon as possible. The more normal the diet is, the quicker is the recovery. Those only having liquids or soft foods tend to have slightly prolonged pain experience. Foods that contain acids such as citrus juices, oranges, tomatoes may cause more discomfort on the raw area at the back of the throat. Some patients may need re-admission into the hospital for dehydration due to lack of oral intake. To avoid re-admission, the patient is encouraged to eat and drink as normal as possible and attend to regular pain relief in the first 5-7 days. Maintaining good fluid intake is very important in the first few days after surgery.

Most patients describe their pain as lasting up to 2 weeks but manageable with oral pain relief. Avoid any heavy strenuous activities, straining, or sport in the first 2 weeks. Children are recommended to stay off school or child care for 2 weeks. Patients can return to simple mild daily activities within the first week.

Antibiotics have not been proven to be of major benefit in the postoperative period. Sometimes antibiotics may be given if there was a strong history of recurrent infections or in the case of UPPP. The lining of the throat will look ‘infected’, yellow/green/gray, for up to 4 weeks before the throat turns into the normal healthy pink colour. If there are stitches used (routinely in UPPP), they will dissolve in the first week or so.

An appointment will be made for 8-12 weeks after surgery if necessary. Most of the time in a routine tonsillectomy, no appointments will be required.

If there are any significant concerns, it is recommended that the patient be seen by a doctor either at the GP practice, the emergency department or the ENT Practice. It is often quite difficult to give a safe advice over the phone without directly examining the patient.