Skeletal muscle in routine tonsillectomy specimens: a common finding

Over the past 10 years, 1 of the authors (D.G.) has been consulted about several medical legal cases involving complications allegedly related to excessive surgery as documented by finding skeletal muscle in tonsillectomy specimens. A review of the literature showed little information about the incidence of skeletal muscle in routine tonsillectomy specimens; therefore, this study was undertaken. Thirty sequential tonsillectomy specimens from patients with histories of hyperplastic tonsils (10 males, 20 females; ages 5, 17 to 39; mean age, 24.3 years) were processed routinely (1 section/tonsil), and evaluated on a retrospective basis using routine light microscopy (group 1). In addition, 20 sequential tonsillectomy specimens were processed in a prospective fashion, excluding sleep apnea specimens (5 males, 15 females; ages 12 to 59 years; mean age, 28.9 years) (group 2). All specimens in the first group had lymphoid hyperplasia; 25 of the 30 (83%) had skeletal muscle in soft tissue adjacent to the lymphoid elements, 20 (67%) had seromucinous glands, and in 1 there was a focus of cartilage. In group 2, 18 had lymphoid hyperplasia and 2 contained carcinomas; 19 of 20 contained skeletal muscle ranging from a single fiber to abundant, multifocal areas with muscle, 16 (80%) had seromucinous glands, and 4 contained areas with cartilage. Additional tissue from the specimen without muscle and the tonsil with a single fiber was processed, and abundant skeletal muscle was identified in each. One may conclude that skeletal muscle is very frequently found in routine tonsillectomy specimens and, by itself, is not an indication of inappropriate surgical technique.