CPT® Code 42820

1. Indications

The tonsillectomy and adenoidectomy procedure is indicated for various conditions that affect the throat and nasopharynx, particularly in pediatric patients. The following are the explicitly provided indications for performing this surgery:

• Recurrent Infections Frequent episodes of tonsillitis or adenoiditis that do not respond to medical management.
• Obstructive Sleep Apnea Symptoms of obstructive sleep apnea due to enlarged tonsils and adenoids, leading to breathing difficulties during sleep.
• Difficulty Swallowing Enlarged tonsils causing obstruction and difficulty in swallowing.
• Speech Impairment Speech issues related to the presence of enlarged adenoids affecting resonance.

2. Procedure

The procedure for tonsillectomy and adenoidectomy involves several detailed steps to ensure the safe and effective removal of the tonsils and adenoids. The following steps outline the surgical process:

• Step 1: Anesthesia and Positioning The patient is placed under general anesthesia to ensure comfort and immobility during the procedure. The patient is positioned appropriately to allow optimal access to the throat.
• Step 2: Mouth Prop Insertion A mouth prop is inserted to keep the mouth open, providing the surgeon with a clear view and access to the tonsils and adenoids.
• Step 3: Tonsil Dissection Clamps are applied to the tonsils to provide traction. The surgeon begins dissection using various techniques, such as scissors, curettes, or cautery. The mucosa is incised with a sickle knife, and dissection proceeds from the superior pole of the tonsil downwards through the connective tissue.
• Step 4: Tonsil Amputation A snare is passed around the tonsil, and the tonsil is amputated by closing the snare loop. The surgical site is inspected for any remaining tonsil tissue, which is removed as necessary.
• Step 5: Hemostasis Bleeding is controlled using pressure, suture ties, or cautery to ensure that the surgical site is stable and free from excessive bleeding.
• Step 6: Adenoid Resection The adenoids are resected using an adenotome, adenoid curette, or microdebrider. The physician retracts the soft palate and positions the curette at the posterior edge of the vomer, pushing it along the nasopharynx to remove the adenoid tissue.
• Step 7: Final Inspection The surgical site is thoroughly inspected for any adenoid remnants, which are removed using a small curette or electrocautery. Hemostasis is achieved through cautery and/or gauze sponges soaked in epinephrine.

3. Post-Procedure

After the tonsillectomy and adenoidectomy, patients are monitored in a recovery area until they are stable. Post-procedure care includes managing pain with appropriate medications, ensuring adequate hydration, and monitoring for any signs of bleeding or complications. Patients are typically advised to follow a soft diet and avoid strenuous activities during the recovery period. Follow-up appointments may be scheduled to assess healing and address any concerns that may arise during the recovery process.