From the Guidelines
The tonsils receive their blood supply primarily from branches of the external carotid artery, including the palatine, lingual, and pharyngeal branches of the facial artery, as well as the pharyngeal branch of the maxillary artery. The palatine tonsils are supplied by the palatine branch of the facial artery, the lingual branch of the facial artery, and the pharyngeal branch of the facial artery. The lingual tonsil is supplied by the lingual branch of the facial artery. The pharyngeal tonsil (adenoids) receives blood from the pharyngeal branch of the facial artery and the pharyngeal branch of the maxillary artery. The tubal tonsils are supplied by the pharyngeal branch of the facial artery. This rich blood supply explains why tonsillectomy procedures can result in significant bleeding if vessels are not properly managed during surgery, as highlighted in a study by Baugh et al 1.
Venous drainage of the tonsils occurs through the peritonsillar plexus, which ultimately drains into the facial vein and then the internal jugular vein. Understanding the tonsils' blood supply is important for surgeons performing tonsillectomies and for managing potential complications like post-operative hemorrhage, as emphasized in a clinical practice guideline update from 2019 1.
Some key points to consider when managing tonsillectomy patients include:
- The risk of primary and secondary bleeding, as reported in studies such as those by Baugh et al 1 and Harms and Adverse Events of Tonsillectomy 1
- The use of NSAIDs for postoperative pain management, which has been shown to be safe and effective in reducing bleeding risk, as demonstrated in studies such as those by Pfaff et al 1
- The importance of follow-up and documentation of bleeding complications, as recommended in the clinical practice guideline update from 2019 1
Overall, a thorough understanding of the tonsils' blood supply and careful management of potential complications are crucial for optimizing patient outcomes and minimizing morbidity and mortality associated with tonsillectomy procedures.
From the Research
Tonsils Blood Supply
The blood supply to the tonsils is primarily provided by the tonsillar artery, which is a branch of the facial artery (FA) 2.
Complications Related to Tonsils Blood Supply
- Post-tonsillectomy hemorrhage (PTH) is a common complication of tonsillectomy, with an incidence estimated at 3-5% of all procedures 2, 3.
- The most consistent risk factors for PTH seem to be patient age and coagulopathies 3.
- Surgeon skill and surgical technique are most consistently associated with primary PTH 3.
- In rare cases, post-tonsillectomy haemorrhage may be caused by the pseudoaneurysm of the facial artery, which can be treated with endovascular embolization 2.
Treatment and Prevention of Post-Tonsillectomy Hemorrhage
- Tranexamic acid (TXA) has been studied as a potential agent to reduce post-tonsillectomy hemorrhage, with some studies showing a significant reduction in blood loss and frequency of post-operative hemorrhage 4.
- However, other studies have found no significant association between TXA administration and reduction in reoperation or blood transfusion rates 5.
- Further large, high-quality clinical trials are still needed to explore TXA's effect on post-tonsillectomy hemorrhage and the safety of its use 4.
Risk Factors for Post-Tonsillectomy Hemorrhage
- Older patients and white ethnicity have been found to have a significantly increased risk of hemorrhage 6.
- Patients with pre-existing comorbidities such as coagulopathy, deficiency anemia, and fluid and electrolyte disorders are also at higher risk of bleeding 6.
- Urban non-teaching hospitals and the Northeast region have been found to have higher rates of hemorrhage 6.