Spontaneous Life-Threatening Hemorrhage Secondary to a Peritonsillar Abscess Requiring Intervention and Local Flap Reconstruction

Spontaneous tonsillar hemorrhage (STH) is a rare but potentially life-threatening complication most commonly associated with tonsillitis and, less frequently, peritonsillar abscess. Prompt recognition and management are critical due to the risk of airway compromise and vascular injury. We report the case of a 30-year-old female who developed massive oropharyngeal hemorrhage following spontaneous drainage of a peritonsillar abscess, requiring emergent airway protection and surgical intervention. The patient underwent Quinsy tonsillectomy, which revealed an extensive defect created by the hematoma communicating with the parapharyngeal and submandibular spaces, placing major cervical vessels at risk. Given the size and depth of the defect, reconstruction was performed using a pedicled buccal fat pad flap to provide vascularized coverage of exposed deep neck spaces. Computed tomography angiography demonstrated close proximity of the peritonsillar space to the facial artery without evidence of pseudoaneurysm or active extravasation. The patient had an uneventful recovery with complete mucosalization of the reconstructed oropharyngeal defect. This case highlights that spontaneous tonsillar hemorrhage following peritonsillar abscess drainage may result in extensive deep neck space involvement requiring not only definitive tonsillectomy but also reconstructive intervention. The successful use of a buccal fat pad flap in this non-oncologic infectious setting expands reconstructive options for complex oropharyngeal defects and underscores its utility in preventing secondary hemorrhage and vascular complications.