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To identify patients undergoing arteriography to verify vascular complications of tonsillectomy, with an emphasis on pseudoaneurysm.
Patients and methods:
We undertook a retrospective analysis of the case records of 8837 patients who had undergone tonsillectomy between 1988 and 2004 at our institution, together with a review of expert reports written for professional boards and civil courts as well as personal experiences or communication. We also conducted a literature review using the PubMed database.
We identified seven cases with vascular abnormalities. In addition, we identified three cases of pseudoaneurysm formation, involving two children and one adult patient, with bleeding 21, 36 and 58 days after tonsillectomy. Successful management included embolisation (two patients) and revision surgery (one patient).
Post-tonsillectomy pseudoaneurysm formation is extremely rare and unrestricted by age. Correct diagnosis depends largely on a high index of clinical suspicion. Delayed and repeated episodes of gushing haemorrhage with spontaneous cessation appear to be a significant clinical marker. Immediate arteriography, with simultaneous embolisation, is highly recommended. The lingual artery is the most commonly involved vessel.
Chondrosarcomas of the larynx (CS) are uncommon and predominantly affect the cricoid cartilage. In the larynx they have a distinctive biological behaviour and require individual treatment. A retrospective study was made on three cases of CS, all presenting with compromise of the upper respiratory tract. The medical history varied from several weeks to six years. Correct diagnosis required open resection of the lesion in all cases. Due to intra-operative findings, all patients underwent total laryngectomy. CS grow slowly and are therefore frequently diagnosed late in the course of the disease. A subglottic bulging of the mucosa should indicate high-resolution-computed-tomography of the larynx to exclude affection of the laryngeal framework. Correct diagnosis of laryngeal cartilaginous tumours requires a complete examination of the entirely resected tumour. Only extended and de-differentiated CS indicate further radical surgery, the remainder call for conservative surgical management.
Bleeding following adenoidectomy is a rare complication of this surgical procedure, and usually occurs in the first post-operative hours. In almost all cases it is related to adenoid remnants. Removal of these remnants under a second general anaesthetic is the treatment of choice. We report a case of massive bleeding three days following adenoidectomy related to the injury of an aberrant ascending pharyngeal artery during adenoidectomy performed elsewhere. Signs of manifest shock necessitated an immediate ligature of the external carotid artery and its individual branches. The post-operative course was uneventful. Two years later the boy underwent tonsillectomy without complications.
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