Treatment of Tonsil Cysts
Tonsil cysts should be surgically excised, typically via tonsillectomy or marsupialization depending on size and location, as these are benign lesions that do not respond to conservative management. 1, 2
Understanding Tonsil Cysts
Tonsil cysts are distinct from the common conditions addressed in tonsillectomy guidelines (recurrent tonsillitis, sleep-disordered breathing). The available evidence consists primarily of case reports rather than systematic guidelines:
- Lymphoepithelial cysts are the most commonly reported type in palatine tonsils, presenting as yellowish masses that may cause recurrent tonsillitis symptoms 2
- These cysts are lined with epithelium and likely have an embryonic origin 3
- They are easily overlooked and require careful examination of tonsillar tissue 2
Treatment Approach
Surgical Management
Complete excision is the definitive treatment:
- Tonsillectomy with cyst removal is the most reliable approach, ensuring complete excision of the cyst along with the affected tonsil 2
- Marsupialization via microlaryngeal approach may be attempted for accessible cysts, though this has documented failure rates requiring subsequent complete resection 1
- For cysts in unusual locations (such as false vocal cord), lateral cervical approach with tracheotomy may be necessary 1
When to Operate
Indications for surgical intervention include:
- Symptomatic cysts causing recurrent tonsillitis 2
- Cysts large enough to cause obstruction or discomfort 1
- Any tonsillar mass requiring definitive diagnosis, as clinical examination alone cannot reliably distinguish cysts from other pathology 2
Important Caveats
Do not confuse tonsil cysts with tonsilloliths (tonsil stones):
- Tonsilloliths are managed expectantly and rarely require surgical intervention 4
- Tonsil cysts require histopathological confirmation and typically need surgical excision 2
Histopathological examination is mandatory to confirm the diagnosis and rule out other pathology, as these lesions are rare and can be mistaken for other tonsillar masses 2
The surgical morbidity for tonsillectomy includes bleeding (0.2-3%), pain, dehydration, and anesthetic risks 5, but these must be weighed against the symptomatic burden and diagnostic uncertainty of leaving a cystic tonsillar mass in place.