Pathophysiology

A fibrin clot develops on the tonsillar fossae within 24 hours of tonsillectomy. Proliferation of the fibrin clot occurs so that by day five there is a thick clot on the fossae. By day 10, mucosa from the periphery of the wound begins to grow inward and the clot begins to separate from the underlying tissue. The risk of a secondary bleed is at its highest at this point.

Risk factors for post-tonsillectomy haemorrhage include

• increasing age
• post-operative infection
• if the indication for surgery was recurrent tonsillitis

Various studies have looked at surgical technique, with conflicting data on rates of post-tonsillectomy bleed. Coblation (the use of radiofrequency) may cause higher rates of post-tonsillectomy bleed.

Learning bite

The risk of a secondary bleed is highest at day 10 post-tonsillectomy.