Childhood Adenotonsillectomy Trial
7.2.4.0 Intra-Operative Tonsillar Photographs
For further quality assurance, intra-operative photographs will be obtained on a 10% sample of patients. Specifically, at each clinical site, each tenth consecutive patient will be photographed in the operating room after being orally intubated under general anesthesia. If for any reason photographs are not obtained, they will then be obtained on the next consecutive patient at that clinical site. The unblinded research coordinator will track all surgical cases and notify the surgeon when operative cases with photos are required. In addition, availability of the equipment necessary to obtain tonsillar photographs must be coordinated with the surgeon and operating room staff prior to the surgery date to ensure all necessary equipment is available.
Necessary equipment includes:
- 0 degree 4 mm wide angel telescope
- 120 degree angled telescope
- Sweetheart or other hand-held-retractor
- Crowe-Davis or other type of mouth gag
- catheter for retraction of the soft-palate
- light source
- digital camera and equipment for storage and electronic transmission of digital images.
The lead otolarygologist at each site will work with the unblinded research coordinator as necessary to facilitate availability of the necessary equipment.
Using a hand-held (sweetheart or other) retractor to optimize visualization by depressing the tongue with sufficient pressure to expose the tonsillar fossae bilaterally, digital photos of the oropharynx before and after tonsillectomy will be obtained using a 4 mm zero degree telescope. Photos of the naso-pharynx pre and post-adenoidectomy will also be obtained using a 120 degree angled telescope with a mouth gag in place and the palate retracted to ensure visualization of the posterior choanae.