Tonsillectomy Patients Often Burned by Defective Cauterizing Devices

<"">Defective cauterizing devices used during tonsillectomy often burn areas around the lips and mouth. As it turns out, these cauterizing device burns are an underreported complication of tonsillectomy that can result in long-term problems, according to a study reported in the Archives of Otolaryngology and Head and Neck Surgery.

Removal of the tonsils (along with the nearby adenoid glands) “remains one of the most commonly performed surgical procedures in the United States,” Dr. Albert H. Park, of The University of Utah School of Medicine, Salt Lake City, and colleagues write. While most patients do very well, a number of complications can occur, included bleeding, pain, and voice changes, Park said.

Cauterization is the burning of a part of the body to either remove that part or close a part of it. In tonsillectomy, surgical removal by scalpel remains the most popular method of tonsil removal practiced by otolaryngologists today; however, cautery devices are sometimes used to remove tonsil tissue or to assist in reducing blood loss. The main forms of cauterization used today are electrocautery and chemical cautery. In the United States, some degree of electrocautery-assisted dissection is most commonly employed because of the ability to rapidly stop bleeding. Some surgeons use very little cautery, but these patients will experience more bleeding and less burned tissue. Research confirms that the heat of the cautery—about 400 degrees Celsius/752 Fahrenheit—will cause thermal injury to surrounding tissue, which can result in increased pain during the post-operative recuperation period.

In this recent study, the research team conducted a review of children and teenagers who suffered a mouth burn during a tonsillectomy conducted at the Primary Children’s Medical Center (PCMC) in Salt Lake City, Utah in the time period from January 1997 to December 2005. The researchers also conducted an online national survey of pediatric ear, nose, and throat doctors and found that of the 4,327 surgeries performed at PCMC, seven patients sustained mouth burns, including one whose burns were serious enough to have necessitated reconstructive surgery. Of 298 surveys sent to physicians, 101 were completed and a total of 61 respondents reported having a patient who developed a burn around the mouth. Of those developing mouth burns from surgery, about ten percent of the burns were severe and required additional treatment.

Research found that most of the burns occurred when the tonsils were removed with devices used to cauterize the area; however, a few cases did occur in those procedures in which a scalpel was the main instrument utilized for tonsil removal and when cautery was used only to keep bleeding under control during the operation.

When cautery devices were used, the most common cause of injury was a defective cautery device tip and not surgeon error. The surgeon’s experience level, by contrast, had no impact on the risk of a mouth burn.

The authors concluded that, “Because tonsillectomy remains one of the most frequently performed procedures, measures to avoid this complication exist and should be considered for every case. In addition, consideration should be given to discussing this potential complication during pre-operative counseling for informed consent.”

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