- Design
- Retrospective comparative case series
- Population
- Children after 5576 tonsillotomies and 19,834 tonsillectomies at one hospital
- Primary outcome
- Later peritonsillar abscess
- Effect
- 0.16% after tonsillotomy vs 0.005% after tonsillectomy; mean 8.2 years later
This retrospective case series from a US tertiary paediatric hospital reviewed children who developed peritonsillar abscess after tonsil surgery performed there between 2010 and 2025, a period with 5576 intracapsular tonsillotomies and 19,834 extracapsular tonsillectomies.
Nine abscesses followed tonsillotomy (0.16%) and one followed tonsillectomy (0.005%). They appeared a mean of 8.2 years after surgery (range 1 to 12), at a mean age of 13.7 years. Residual tonsil tissue was confirmed in seven of ten, and five had revision tonsillectomy.
The absolute risk is low and tonsillotomy's advantages in early pain and bleeding are well established. But an adolescent with a sore throat, trismus and a history of tonsil surgery in early childhood may still have tonsil tissue, and a GP or emergency doctor should not discount abscess on the grounds that the tonsils were removed. Case capture relied on presentations to one institution, so the true rates are uncertain.
- Ask whether previous tonsil surgery was a tonsillotomy (partial) or a tonsillectomy (complete).
- Do not exclude peritonsillar abscess in a child with sore throat, trismus or uvular deviation because the tonsils were removed.
- Mention the small long-term abscess risk when counselling families about tonsillotomy.
- Consider revision tonsillectomy after an abscess where residual tissue is found.
Why it matters
Partial tonsil surgery is increasingly common in children, and the residual tissue it leaves can cause problems a decade on.
Don't overread it
A ten-case series cannot give a reliable risk estimate or outweigh tonsillotomy's short-term advantages.
The statistics, in plain English
A rate of 0.16% is about one or two abscesses for every thousand tonsillotomies. The comparison with tonsillectomy rests on ten cases, so the size of the difference is very imprecise. Patients who presented elsewhere would not have been counted.
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