Peritonsillar Abscess Status Post Prior Tonsillotomy: A Potential Long‐Term Risk

OBJECTIVE: Peritonsillar abscess (PTA) after surgical tonsil removal is an infrequent complication. Residual lymphoid tissue after tonsillotomy may increase this risk compared to tonsillectomy. This study aimed to identify cases of PTA following tonsillotomy or tonsillectomy in a pediatric population and compare the incidence and case details. STUDY DESIGN: Retrospective comparative case series. SETTING: Tertiary pediatric hospital. METHODS: A review was conducted of patients ≤18 years of age who underwent tonsillotomy or tonsillectomy from January 2010 to January 2025 and later presented with PTA. Among 5576 tonsillotomies and 19,834 tonsillectomies performed, 10 patients were identified in whom PTA occurred after tonsil surgery at the study institution, and for whom complete medical records were available. RESULTS: Nine cases of PTA occurred after tonsillotomy (0.16%) and one after tonsillectomy (0.005%). The mean interval (±SD) from tonsil surgery to PTA diagnosis was 8.2 ± 3.0 years (range, 1-12 years). Mean age at PTA diagnosis was 13.7 ± 2.3 years (range, 10-18 years). Residual tonsillar tissue was confirmed in seven of ten patients; five underwent revision tonsillectomy. CONCLUSION: The benefits of tonsillotomy over tonsillectomy with respect to short-term postoperative morbidity are well established. Although the long-term risk of PTA secondary to residual lymphoid tissue is low, otolaryngologists should be aware of this possible outcome when counseling patients preoperatively as to intracapsular tonsillotomy versus extracapsular tonsillectomy, and when treating patients with pharyngeal symptoms with a history of prior intracapsular tonsillotomy. LEVEL OF EVIDENCE: 4 (Case series).