(2) The tonsil is grasped with a pair of tonsil-grasping forceps and the
mucous membrane of the anterior pillar incised with a knife; the tonsil lobe is freed from
its attachments to the pillars with a tonsil dissector, curved scissors, and gauze sponges
on a holder. The tonsil is withdrawn with forceps.
(3) The posterior pillar is cut with scissors, and the tonsil is removed with a
snare. In some cases, the LaForce or Sluder tonsil guillotine clamp may be used.
A tonsil sponge is placed in the fossa by a hemostat.
(5) Bleeding vessels are clamped with tonsil forceps, tied with slipknot
ligatures of absorbable suture and the free ligature ends are cut.
(6) The adenoids are removed with an adenotome or curette. Bleeding is
controlled by pressure with sponges.
(7) The fossa is carefully inspected, and any bleeding vessels are clamped
and tied. Retractors are removed, the face of the patient is cleaned, and his head is
turned to one side. The patient is kept in the semirecumbent (Fowler) position or on his
side horizontally, to avoid aspiration of blood and venous engorgement.
e. Handling of Specimens. Tissue excised is processed for examination by
f. Suturing Types Usually Used.
Absorbable suture of size specified by the surgeon--used for free
(2) Absorbable suture, of size specified by the surgeon, affixed on tonsil
needle--used for suture-ligature.
1-37. SURGERY OF THE ORAL CAVITY
a. General. This procedure consists of the excision of benign or malignant
lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar
area. Benign or small malignant tumors of the oral cavity may be excised without neck
dissection. In the presence of tongue cancer without evidence of metastasis, a
"prophylactic" neck dissection may be performed in an effort to control a cancerous
growth in the upper jugular chain of the neck. When treating a typical carcinoma of the
floor of the mouth with involvement of the mandible, a portion of the tongue and the
mandible are removed. When there is a lesion of the tonsil or an extensive lesion at the
base of the tongue with pharyngeal wall involvement, a resection of the ascending
ramus of the mandible is necessary, and portions of the base of the tongue, pharyngeal
wall, and the soft palate are removed to secure an adequate margin of normal tissue
about the lesion.