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.