A 3-year-old child undergoes adenotonsillectomy for recurrent tonsillitis meeting Paradise criteria. In the immediate postoperative period, which is the most dangerous and immediately life-threatening complication?

• A Nasopharyngeal stenosis
• B Velopharyngeal insufficiency
• C Atlanto-axial subluxation (Grisel's syndrome)
• D Post-tonsillectomy hemorrhage within 24 hours (primary hemorrhage) ✓

Explanation

Primary (reactionary) hemorrhage within the first 24 hours post-tonsillectomy is the most immediately life-threatening complication due to the risk of airway compromise from clot and the child's small blood volume — even modest bleeding can cause hemodynamic instability. Secondary hemorrhage at 5–10 days is more common but less immediately catastrophic. Grisel's syndrome (rotatory subluxation of C1–C2) is a serious but rare delayed complication. Velopharyngeal insufficiency is more common after adenoidectomy in patients with submucous cleft palate.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.