Hemorrhage from the oral cavity after tonsil surgery is a common and potentially life-threatening surgical complication Expeditious triaging and accurate examination of the patient who presents with a bleed will help determine which patients are safe to be conservatively observed and which require urgent surgical intervention Otolaryngology consultation is warranted for all actively bleeding patients and for those who present with fresh clots in the tonsil fossae CLINICAL PEARLS AND PITFALLS Bleeding from the inferior tonsil pole is often difficult to identify; a thorough examination of the oral cavity using tongue depressors is imperative IV access and resuscitation is critical, as blood loss can be more significant than expected This is especially important for children under age years If the tonsil fossae are completely void of any bleeding or clots, consider adenoid bed hemorrhage or epistaxis in the differential Current Evidence Tonsil and adenoid surgery is among the most common pediatric surgeries, with over 500,000 outpatient surgeries performed annually in the United States Posttonsillectomy hemorrhage (PTH) is the most frequent serious complication and occurs in 3% to 5% of younger children and up to 10% of adolescents Bleeds are classified as either a primary or secondary PTH—a primary bleed occurs within 24 hours of the original surgery; secondary bleeds occur after 24 hours Risk factors for hemorrhage include male gender, older age, and infectious indication for surgery The tonsil is a highly vascular organ, with a blood supply from multiple carotid branches including the facial, lingual, ascending pharyngeal, and maxillary arteries With the modern electrocautery device, intraoperative bleeding has been reduced to a minimum, and primary PTH rates have declined considerably compared to a cold steel technique The rates of secondary PTH, on the other hand, have been consistent, as it is considered to be more of a function of the healing process An eschar forms in the fossa after tonsil removal; this eschar typically sloughs off between and 10 days postoperatively, and this is when most secondary PTH occurs Two types of tonsil surgeries are performed in the United States A total tonsillectomy, also known as an extracapsular tonsillectomy, involves removal of