Torrential bleed during tonsillectomy is due to –
**Core Concept**
During tonsillectomy, torrential bleeding can occur due to the rich vascular supply of the tonsillar bed, particularly from the tonsillar arcade and the branches of the superior and middle pharyngeal constrictors. The blood vessels in this region are highly susceptible to trauma during surgical dissection.
**Why the Correct Answer is Right**
The correct answer is **D. Disruption of the tonsillar arcade**. The tonsillar arcade is a vascular network that provides a rich supply of blood to the tonsil. During tonsillectomy, if the arcade is not properly ligated or if it is inadvertently torn, it can lead to torrential bleeding. This is because the arcade acts as a "safety net" for the tonsil, providing an alternate blood supply in case of injury to individual vessels.
**Why Each Wrong Option is Incorrect**
**Option A:** While coagulopathy can contribute to bleeding, it is not the primary cause of torrential bleeding during tonsillectomy.
**Option B:** Hypertension is not directly related to the vascular supply of the tonsil and is therefore not a relevant factor in this context.
**Option C:** While infection can occur after tonsillectomy, it is not a cause of bleeding during the procedure.
**Clinical Pearl / High-Yield Fact**
It is essential to identify and ligate the tonsillar arcade during tonsillectomy to prevent postoperative bleeding. This can be achieved by using electrocautery to dissect the arcade from the surrounding tissue.
**Correct Answer:** D. Disruption of the tonsillar arcade