Table 4. Synchronous and contralateral tonsillar tumours. IL: ipsilateral. BL: bilateral, CL: contralateral. PE: panendoscopy. Ix: Investigation. Ex: examination. BOT: base of tongue, PT: palatine tonsillectomy, TORS: trans-oral robotic assisted surgery, TBM: tongue base mucosectomy
Complications
When considering unilateral or bilateral tonsillectomy over biopsies, the incidence of complications is an important deciding factor. Overall there was a lack of documented complications. Podeur et al19 noted a haemorrhage rate of 6% in their cohort of unilateral and bilateral tonsillectomies in 63 patients. This is in keeping with the national post-tonsillectomy bleed rate. Lapeyre et al21 had no specific complications related to tonsillectomies. Low complication rates support the recommendation of bilateral tonsillectomy.
HPV related tumours
There were several studies which specifically looked at HPV or P16 positivity and detection rates in the palatine tonsils27,19,24 (table 5). HPV positivity correlated with oropharyngeal primary in general. Due to the nature of HPV associated tumours, they are less likely to be picked up on random deep tissue biopsies. This pertains to the increased pickup rates associated with tonsillectomy. Vent et al27 suggest that P16 can be used as a marker of oropharyngeal primary, directing investigation. Podeur et al19 go further and suggest that the indication of an oropharyngeal primary in this subset of patients should prompt an extended investigation including bilateral tonsillectomy and possible tongue base mucosectomy (TBM) in these patients, but not in P16 negative patients.
However, it must be borne in mind that HPV positive tumours have been detected in the nasopharynx28. This topic will be re-visited in the management of the base of tongue and in particular the subgroup of patients where novel techniques can be used.