In 2016, the group led by Claudio Vicini—a pioneer in the use of Transoral Robotic Surgery (TORS) for benign tongue base conditions—published a first paper on robotic-assisted treatment of lingual tonsillitis (1). Their findings were later expanded in a 2020 publication, reporting outcomes in a series of 84 patients with adequate follow-up (2).
Postoperative endoscopic evaluation showed that most patients (94.1%) had absent or minimal lymphoid tissue remaining at the tongue base. Importantly, there was a significant reduction in the mean number of acute lingual tonsillitis episodes per year—from 5.17 down to 0.54 events.
More recently, a Dutch group published updated results from a cohort of 33 patients, confirming similar outcomes. TORS appears to be an effective and safe treatment for chronic lingual tonsillitis, improving both swallowing function and overall quality of life, while significantly reducing tonsillitis-related symptoms (3).
Yet, this remains an unusual indication for surgery—despite the theoretical parallels to chronic palatine tonsillitis, which remains a common reason for tonsillectomy in adults. Why?
Let’s analyze the situation.
First, the true incidence of lingual tonsillitis is largely unknown. The symptoms—odynophagia, foreign body sensation, chronic throat discomfort—are common, but diagnosis requires a laryngoscopy. This means the patient must see an ENT specialist who then decides to perform this examination.
Anatomically, the boundaries of the lingual tonsils are well-defined at the deep limit (lingual muscles), medial (midline), inferior (vallecula), and superior (vallate papillae and glosso-tonsillar sulcus). However, the lateral boundaries are less clear, as lymphoepithelial follicles can extend quite far laterally. As a result, surgical resection is typically subtotal rather than complete.
Most surgeons avoid lingual tonsillectomy—unless TORS is available. With robotic assistance, the procedure becomes considerably more straightforward and safe, allowing precise resection with better visualization and control.
There is no compelling reason why surgical indications for lingual tonsillitis should differ from those for palatine tonsillitis. Of course, more data and controlled studies are needed, but this is a logical starting point: document the episodes, and if the patient suffers recurrent lingual tonsillitis, offer surgery as a treatment option.
As always, this remains a relative indication (as for palatine tonsillectomy in recurrent tonsillitis cases). The final decision must lie with the patient. But let’s not discard this option simply because the surgeon cannot offer it. With TORS, we now have a reliable and minimally invasive tool—it’s time to bring lingual tonsillectomy into the conversation.
J Granell. May 16, 2025
References
- Montevecchi F, Cammaroto G, Meccariello G, D’Agostino G, Hsu YS, Galletti B, Vicini C. Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail. Int J Med Robot. 2017 Sep;13(3). doi: 10.1002/rcs.1763. Epub 2016 Aug 2.
- Di Luca M, Iannella G, Montevecchi F, Magliulo G, De Vito A, Cocuzza S, Maniaci A, Meccariello G, Cammaroto G, Sgarzani R, Ferlito S, Vicini C. Use of the transoral robotic surgery to treat patients with recurrent lingual tonsillitis. Int J Med Robot. 2020 Aug;16(4):e2106. doi: 10.1002/rcs.2106. Epub 2020 Apr 2.
- Toppenberg AGL, Plaat RE, Schwandt LQ. Transoral Robotic Surgery in Chronic Lingual Tonsillitis: An Observational Cohort Study. Head Neck. 2025 Jun;47(6):1665-1673. doi: 10.1002/hed.28074. Epub 2025 Jan 22. PMID: 39840439; PMCID: PMC12068535