- Design
- Retrospective comparative case series, single tertiary centre
- Population
- 5,576 tonsillotomies and 19,834 tonsillectomies in children, 2010–2025
- Primary outcome
- Later peritonsillar abscess
- Effect
- 0.16% after tonsillotomy vs 0.005% after tonsillectomy; mean interval 8.2 years
A US tertiary paediatric centre reviewed tonsil surgery from 2010 to 2025: 5,576 intracapsular tonsillotomies and 19,834 extracapsular tonsillectomies. It identified ten later peritonsillar abscesses with complete records.
Nine followed tonsillotomy (0.16%) and one followed tonsillectomy (0.005%). The mean interval was about eight years (range 1–12), and mean age at abscess was about 14. Residual tonsil tissue was confirmed in seven, and five had revision tonsillectomy.
Tonsillotomy has clear short-term advantages — less pain and less bleeding. This series does not change that balance, but it adds a small, late risk families should hear about, and it should prompt clinicians to think of abscess in an adolescent with a past tonsillotomy, rather than dismissing it because the tonsils were 'removed'.
- Mention a small long-term risk of regrowth and peritonsillar abscess when consenting for tonsillotomy
- Record the type of tonsil surgery clearly in the operation note and discharge summary
- Consider peritonsillar abscess in a teenager with prior tonsillotomy and unilateral throat pain or trismus
- Look for residual tonsil tissue on examination before excluding the diagnosis
Why it matters
Challenges the assumption that a child whose tonsils were operated on cannot develop a peritonsillar abscess.
Don't overread it
A single-centre case series that may undercount events; it does not weigh the short-term benefits of tonsillotomy.
The statistics, in plain English
The risk after tonsillotomy was about 1 in 600 over the study period, against about 1 in 20,000 after tonsillectomy. These are minimum figures: children treated elsewhere for an abscess would not have been captured.
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