There is a long-standing debate regarding either unilateral or bilateral tonsillectomy for histological confirmation of tonsil cancer. Bilateral tonsillectomy is the standard of care in Denmark for proven or suspected tonsil carcinoma, and in the diagnostic work-up of the unknown primary. This is a retrospective study from a single centre in Denmark assessing the prevalence of synchronous bilateral tonsil cancer over a 16-year period (January 2000 – December 2015). Patients with large tumours involving both tonsils were excluded. Seven of 211 (3.3%) eligible patients had synchronous tonsil carcinomas. None of these synchronous primaries were suspected clinically.

Three of 34 patients (8.8%) with an unknown primary had bilateral tonsil carcinoma. Two further patients had moderate-severe dysplasia of the contralateral tonsil (<1%).

The authors recommend bilateral tonsillectomy in the work up of suspected tonsil carcinomas and the unknown primary. I tend to agree. 

Prevalence of synchronous bilateral tonsil squamous cell carcinoma: a retrospective study.
Rokkjaer MS, Klug TE.
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Serge Latis

Liverpool Hospital, Sydney, NSW, Australia.

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