Introduction: Asymptomatic unilateral tonsillar enlargement is usually treated with systematic tonsillectomy under suspicion of malignancy. Due to the fact that most of the cases are benign pathologies, we set out to study the clinical signs that would help us in the diagnosis in order to avoid unnecessary tonsillectomies.
Material and methods: We reviewed 267 tonsillectomies performed from 1996 to 2006 and 30 of these were indicated because of asymmetry. We evaluated risk factors for malignancy: cervical lymphatic node enlargement, sex, age, tonsillar enlargement noticed by the patient, suspicious appearance, systemic symptoms, history of malignancy and immunocompromise.
Results: Histopathologic study revealed 80 % to be benign and 20 % malignant. The risk factors with the strongest association were enlargement of cervical lymphatic nodes and suspicious appearance of the tonsil.
Conclusions: Strict control of a unilateral tonsillar enlargement is possible, but it is mandatory to perform a tonsillectomy when the appearance of the tonsil raises suspicions or there are enlarged lymphatic nodes.