Unilateral versus bilateral abscess tonsillectomy. Implications for current surgical practice.

OBJECTIVES

To compare unilateral vs bilateral hot tonsillectomy in managing peri-tonsillar abscesses.

METHODS

Literature review in Medline and other database sources, and critical analysis of data.

RESULTS

Management options for peri-tonsillar abscesses range from intravenous antibiotics alone or needle aspiration for small collections to incision and drainage or abscess tonsillectomy for larger ones. Regarding the latter, there is no clear consensus in the literature on favouring unilateral over bilateral excision.

CONCLUSION

Conventional wisdom would suggest that operating on acutely inflamed tissue may increase the risk of bleeding due to engorged vessels and tissue friability. The potentially lower rate of post-operative haemorrhage in unilateral abscess tonsillectomy should be weighed against a potentially lower risk of future episodes in bilateral excisions. Furthermore, the improved efficiency of unilateral abscess tonsillectomy in terms of healthcare resource utilisation and operative time should be evaluated in the context of routinely performed interval contralateral tonsillectomies, potentially affecting operating theatre planning.