Q. What could be the possible cause of asymmetrical posterior tonsil pillar?

Answered by Dr. Murari. M. and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 11, 2023

Hello doctor,

I have a slightly asymmetrical posterior tonsil pillar on the right side. I do not have any other symptoms like pain, swelling, etc.

What could be the reason? Please help.

Thank you.

MBBS., MS OTORHINOLARYNGOLOGY (ENT
Otolaryngology (E.N.T)

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern. In the images (attachment removed to protect the patient’s identity), the entire tonsil and oropharynx are not visible. But, the visualized areas do not show any sinister growth or ulceration, and the uvula appears central. Tonsils can persist in about 10 to 15 percent of adults, however, when they are asymmetrical (i.e. of different sizes) there is a risk of underlying cancer. Hence, it is of utmost importance to see both tonsils together along with the whole throat and some close-up images of the tonsils individually. If you could provide these images, I would be able to make a more accurate and comprehensive diagnosis. Also, can you kindly elaborate on any other throat symptoms, any tonsil surgery in the past, and smoking or alcohol history? And any history of significant diseases or treatments including cancer.

Thank you.

Differential diagnosis:

Asymmetric tonsil- inv to rule out tonsillar cancer.

Treatment plan:

I would suggest you keep a close watch and look for any new changes in shape, size, or ulceration. Follow up with details and images.

Regarding follow-up:

I would suggest if any new changes in shape, size, or ulceration are found, follow up with further details and images.


Differential diagnosis:

Asymmetric tonsil- inv

To rule out Tonsillar cancer.

Treatment plan:

Keep a close watch and look for any new changes in shape, size or ulceration.

Follow up with details and images.

Regarding follow up:

Keep a close watch and look for any new changes in shape, size or ulceration.

Follow up with further details and images.

Hello doctor, thank you so much for the reply.

I have added an image that has a better view of both sides.

MBBS., MS OTORHINOLARYNGOLOGY (ENT
Otolaryngology (E.N.T)

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern. Thanks for the image (attachment removed to protect the patient’s identity), I would suggest the probabilities are of tonsilolith but cancer also needs to be ruled out.

Differential diagnosis:

The probabilities are of tonsilolith but cancer needs to be ruled out.

Treatment plan:

I would suggest you maintain oral hygiene and active surveillance.

Regarding follow-up:

I would suggest you follow up with a comprehensive history for reaching a definitive diagnosis as already mentioned along with the clinical findings. There is a whitish area on the tonsil which is unfortunately not very clear and needs careful evaluation.


Differential diagnosis:

The probabilities are of tonsilolith but cancer needs to be ruled out.

Treatment plan:

I would suggest you maintain oral hygiene and active surveillance.

Regarding follow up:

I would suggest you follow up with a comprehensive history for reaching a definitive diagnosis as already mentioned along with the clinical findings. There is a whitish area on the tonsil which is unfortunately not very clear and needs careful evaluation.


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