Incidence of Peritonsillar Abscess after Intracapsular and Extracapsular Tonsillectomy

SAN DIEGO-A peritonsillar abscess (PTA) is an infection typically occurring in the potential space later to the tonsil. Although, in theory, it should not occur after tonsillectomy, there have been reported cases suggesting that PTA may be due to tonsillar remnants or minor salivary glands in fossae. There have also been reports of PTA after radiofrequency ablation.

Ellen S. Deutsch, MD

In a research study presented April 29 during the American Society of Pediatric Otolaryngology program at the Combined Otolaryngology Spring Meeting, Ellen S. Deutsch, MD, discussed the incidence of PTA after intracapsular and extracapsular tonsillectomy. Her team’s findings indicated that the infrequent occurrence of PTA following intracapsular tonsillectomy does not achieve statistical significance.

A pediatric otolaryngologist with Alfred I. duPont Hospital for Children in Wilmington, DE, Dr. Deutsch and her team conducted a retrospective chart review of 3760 patients who underwent tonsillectomy between January 2000 and December 2004, as well as all patients with peritonsillar abscesses. Of those undergoing tonsillectomy, 52% were male, about 40% were between the ages of three and five years, and 94% underwent both tonsillectomy and adenoidectomy.

Incidence of PTAs

The most common indication for tonsillectomy was tonsillar hypertrophy, followed by recurrent tonsillitis, or both. During the study period, 62 patients had PTAs. Acute management comprised surgical incision and drainage (37%) or acute extracapsular or intracapsular tonsillectomy (27% and 8% respectively), with 27% of patients treated medically.

Extracapsular tonsillectomy was performed on 2273 patients. Dr. Deutsch explained that in this procedure, the entire tonsil is removed, using the capsule as demarcation of resection. Intracapsular tonsillectomy was performed on the remaining patients. Noting that the number of intracapsular tonsillectomies is increasing yearly, Dr. Deutsch said that this procedure involves a layer of tonsil tissue and capsule remaining in the fossae; there is decreased postoperative discomfort following this procedure, and the peritonsillar (potential) space remains present.

Although the incidence of outpatient visits increased 1.4-fold and the number of tonsillectomies increased 1.7-fold during the study period, the incidence of PTA relative to incidence of tonsillectomy did not significantly change (p = 0.8), Dr. Deutsch reported.

After tonsillectomy, only two patients, both of whom had intracapsular tonsillectomy for tonsillar hyperplasia, had PTA. One underwent unilateral incision/drainage and the other had a complete bilateral extracapsular tonsillectomy. Neither has had a recurrence of PTA.

Dr. Deutsch said these two cases occurred early in the series and may have been related to the surgical technique.

In her conclusion, Dr. Deutsch said that although the infrequent occurrence of PTA following tonsillectomy was not statistically significant, the etiology and optimal treatment of PTA remain points of medical debate.

©2007 The Triological Society