Unilateral radiotherapy for well-lateralised oropharyngeal squamous cell carcinoma reduces treatment toxicity. This study evaluated whether routine contralateral tonsillectomy, performed to look for synchronous tonsillar malignancies, is justified.

A retrospective analysis was conducted of 81 patients treated with curative intent for oropharyngeal squamous cell carcinoma at a tertiary centre (2022–2024). All patients underwent positron emission tomography computed tomography. Contralateral tonsillectomy was performed in candidates for unilateral radiotherapy.

Forty-two patients underwent contralateral tonsillectomy. Synchronous contralateral squamous cell carcinoma was identified in one patient (2.4 per cent) who required bilateral cervical chemoradiation because of extranodal extension found on neck dissection. Eleven patients (26 per cent) underwent staged procedures after a median interval of 21 days. Post-tonsillectomy haemorrhage requiring hospital re-admission occurred in one patient (2.4 per cent).

Routine contralateral tonsillectomy did not yield any findings that altered the laterality of treatment in any patient. This suggests that omitting contralateral tonsillectomy may complement de-escalation strategies.