Mouth burns during tonsillectomy underreported

NEW YORK (Reuters Health) - Burns around the lips and mouth - primarily from the use of a cauterizing device -- are an underreported complication of tonsillectomy, and 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.

In the present study, the team conducted a review of children and teens who sustained a mouth burn during a tonsillectomy at Primary Children's Medical Center (PCMC) in Salt Lake City between January 1997 and December 2005. In addition, they conducted an online national survey of pediatric ear, nose, and throat doctors.

Of the 4,327 surgeries performed at PCMC, 7 patients sustained mouth burns, including one that required reconstructive surgery.

Of 298 surveys sent to physicians, 101 were completed. A total of 61 respondents reported having a patient develop a burn around the mouth. Roughly 10 percent of the burns were severe, necessitating additional treatment.

As expected, most of the burns occurred when the tonsils were removed with devices used to cauterize the area. However, a few cases accured even when a scalpel was the main instrument for removal and cautery was simply used to control bleeding.

The most common cause of injury was a defective cautery device tip. The surgeon's experience level, by contrast, had no impact on the risk of a mouth burn.

The authors conclude 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 preoperative counseling for informed consent."

SOURCE: Archives of Otolaryngology and Head and Neck Surgery, January 2008.