It is unusual for a parapharyngeal abscess (PA) to occur late after an adenotonsillectomy. We report herein a 13-year-old female patient who developed a PA a year after an uneventful adenotonsillectomy. The patient underwent 2 surgical explorations and was given intravenous antibiotic treatment. She was discharged in good general condition after spending 7 days in hospital. The potential pathophysiological mechanisms behind PA formation late after tonsillectomy or adenotonsillectomy, and rational treatments for PA are critically discussed.

Keywords: adenotonsillectomy, deep neck infection, parapharyngeal abscess, pediatric, rational treatment