Introduction: Most hospitals routinely examine microscopically all tonsillar and adenoid specimens from healthy pediatric patients complaining of recurrent infections or obstructive sleep apnea. Concern over missing the rare, unsuspected and significant diagnosis propagates this practice. Clinical examination for asymmetry could obviate the need for routine microscopic examination of tonsil and adenoid specimens in patients aged 16 years old and younger. Methods: A prospective controlled trial was carried out in one institution using database of 305 patients aged 16 years or younger who underwent tonsillectomy and/or adenoidectomy between 2003 and 2007 at the Shaheed Sadoughi Hospital .Patients with unilateral tonsillar enlargement were entered in this study. Patients who had risk factors for malignancy were excluded. After excision, two tonsil specimens were measured before sending for histological examination. Matched controls with symmetric tonsils underwent the same procedures. Preoperative diagnosis of tonsil asymmetry with the postoperative histological diagnosis was evaluated. Results: Of the 305 patients undergoing tonsillectomy, 106 patients (34.75%) had asymmetric tonsils. In the control group 102 patients had symmetric tonsils. The analysis showed statistically no significant difference in the age, sex, indication of surgery and type of surgery between the two groups. Most of the specimens had reactive lymphoid hyperplasia in both the groups (58.49% and 54.9%, respectively). Histological examination showed no malignancies or unusual pathological findings in both the groups. Discussion: Tonsil asymmetry may be apparent in patients with normal physical examination, secondary to benign hyperplasia or anatomical factors. Therefore, the presence of tonsil asymmetry without risk factors like progressive enlargement of the tonsil, concomitant neck adenopathies, history of malignancy or immunocompromise may not indicate malignancy. Microscopic examination of all routine tonsils and adenoids for individuals aged 16 years or less is not indicated, but careful gross examination is still recommended.

Keywords: Adenoid, Tonsil, Pathological, Unilateral tonsillar enlargement

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