Tonsillolith: a case report

Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images

OBJECTIVES

Palatine tonsilloliths incidentally detected on diagnostic imaging should be differentiated from pathologic calcifications to enable correct diagnosis and treatment. The aim of this study is to clarify the prevalence and imaging characteristics of palatine tonsilloliths on panoramic radiographs.

MATERIALS AND METHODS

We retrospectively reviewed 2244 individuals who underwent pairs of consecutive panoramic radiography and computed tomography (CT) of the head and neck region. The imaging characteristics of palatine tonsilloliths on panoramic radiography were compared with the findings from CT, which was considered the gold standard.

RESULTS

Tonsilloliths were detected in 300 (13.4 %) and 914 (40.7 %) of the 2244 individuals on panoramic radiographs and CT, respectively. On panoramic radiographs, tonsilloliths were superimposed over the ramus of the mandible at the level coincident with and inferior to the soft palate in 176 (7.8 %) and 90 (4.0 %) individuals, respectively. Tonsilloliths were also superimposed over the surrounding soft tissue inferior to the body of the mandible, postero-inferior to the angle of the mandible, and posterior to the ramus of the mandible in 33 (1.5 %), 26 (1.2 %), and 28 (1.3 %) individuals, respectively. A significant correlation was observed between the detectability on panoramic radiographs and the size (Spearman r = 1.000) and number (Spearman r = 0.991) of tonsilloliths, as revealed by CT images.

CONCLUSIONS

The present results suggest that tonsilloliths are commonly detected on panoramic radiographs. Furthermore, they can be superimposed on both the mandible and the surrounding soft tissue.

CLINICAL RELEVANCE

Clinicians should include tonsilloliths among the differential diagnoses when calcified bodies are detected on panoramic radiographs.

Prevalence and imaging characteristics of palatine tonsilloliths detected by CT in 2,873 consecutive patients

Aim. Tonsilloliths are calcified structures that develop in tonsillar crypts. They are commonly detected in daily clinical practice. The prevalence of tonsilloliths was 16 to 24% in previous reports, but it is inconsistent with clinical experience. The aim of this study is to clarify the prevalence, number, and size distribution of tonsilloliths using computed tomography (CT) in a relatively large number of patients. Materials and Methods. We retrospectively reviewed the scans of 2,873 patients referred for CT examinations with regard to tonsilloliths. Results. Palatine tonsilloliths were found in 1,145 out of 2,873 patients (39.9%). The prevalence of tonsilloliths increased with age, and most commonly in patients of ages 50–69. The prevalence in the 30s and younger was statistically lower than in the 40s and older (P < 0.05). The number of tonsilloliths per palatine tonsil ranged from one to 18. The size of the tonsilloliths ranged from 1 to 10 mm. For the patients with multiple CT examinations,the number of tonsilloliths increased in 51 (3.9%) and decreased in 84 (6.5%) of the tonsils. Conclusions. As palatine tonsilloliths are common conditions, screenings for tonsilloliths during the diagnosis of soft tissue calcifications should be included in routine diagnostic imaging.

The prevalence of tonsilloliths and other soft tissue calcifications in patients attending oral and maxillofacial radiology clinic of the university of iowa

Objective. The purpose of this study was to determine the prevalence of tonsiliths in patients attending the oral and maxillofacial radiology clinic of The University of Iowa and to determine if there is any correlation between the presence of tonsiliths and the presence of stones in other body tissues, ducts, or organs. Study Design. This was a two-part study. The first part was a prevalence study whereas the second was a matched pair case-control study. The matched pair case-control study commenced after the prevalence study was concluded. No new or unusual radiographs were made in this study. The study only reviewed radiographs that were made for clinical purposes. Results. A total of 1524 pantomographs were reviewed and 124 subjects (53 males and 71 females) aged 9 years and 2 months to 87 years (mean age 52.6 years) were included for data analysis. Thirty-eight subjects had single tonsiliths whereas 86 subjects had multiple tonsiliths. The prevalence of tonsiliths in the study population was 8.14%. A total of 20 subjects were included in the second part of the study, comprising 10 each for matched pair case-control groups. The observations did not indicate any correlation between the presence of tonsiliths and the presence of stones in other body tissues, ducts, or organs. Conclusion. The prevalence of tonsiliths in our study population was 8.14%. The observations in our study do not support any correlations between tonsiliths and calcifications in other body tissues, organs, or ducts.

Transoral sonographic diagnosis of tonsilloliths: report of 3 cases

Tonsilloliths are calcified concretions that develop in tonsillar crypts. They are usually asymptomatic; however, they may cause problems such as halitosis, dysphagia, a globus sensation, and otalgia. Tonsilloliths may be diagnosed by a simple inspection or palpation of tonsillar crypts, which can be confirmed by panoramic radiography, computed tomography, or magnetic resonance imaging. We report 3 cases of tonsilloliths diagnosed by transoral sonography that was performed easily and comfortably in an office-based setting.

Tonsillolithiasis and orofacial pain

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.

A giant tonsillolith

Tonsilloliths or calculi of the tonsil are calcifications that form in the crypts of the palatine tonsil or around it. Small concretions are asymptomatic while large calcifications produce symptoms such as odynophygia, dysphagia and referred otalgia. We describe a case of a 24 years old female who presented with a six month history of mild throat discomfort and was found to have a large (3.1 × 2.7 × 2.1 cm) calculus in her left tonsil for which a tonsillectomy was done. This is one of the largest reported cases in the world. The authors stress that symptoms of tonsillolith are unrelated to its size. The pertinent literature has been reviewed.

Tonsillolith--report of an unusual case

Tonsilloliths are rare concretions found in the tonsillar crypt. They are usually single and unilateral, but occasionally may be multiple or bilateral. This report describes a case of a 47-year-old woman whose radiography revealed one radiopaque image located in the right ramus of the mandible. The patient revealed a history of slight dysphagia, halitosis and swallowing pain with a foreign body sensation. Her medical history revealed a tonsillectomy when she was eight years old and the removal of the uvula because of sleep apnoea six years ago. Computer tomography showed a delimited and calcified oval image measuring 0.6 x 0.6 cm. The tonsillar concretion might have been formed because of a calcification of the lymphoid tissue. On the patient's request, surgical excision was not performed and she will be monitored due to the tendency of such lesions to grow.

Bilateral tonsillolithiasis: a case report

Although tonsilloliths are reported to be fairly common, florid cases casting distinct radiopaque shadows on panoramic radiographs are not often reported. This report illustrates such a case as an incidental finding in an asymptomatic 38-year-old female dental patient. Panoramic radiography revealed distinct radiopaque shadows over the ascending rami of the mandible bilaterally. These radiopacities were localized to the palatine tonsils by computerized tomographic inspection. Tonsillectomy was performed and tonsillolithiasis was confirmed by histopathologic examination.

An unusual tonsillolithiasis in a patient with chronic obstructive sialoadenitis

Concretions in the tonsil or peritonsillar area are an infrequent entity in clinical practice. Some patients have no symptoms or they can present with fetor oris or odynophagia. The lesions are often detected incidentally during radiographic examination. This pathology can be related to lithiasis in other regions of body. The authors describe a tonsillolith accidentally detected in a patient with a lithiasis of left submandibular gland. We review published cases of tonsilloliths and analyse the causes of stone formation in peritonsillar and tonsil regions.

An unusual tonsillolith

A case of a large tonsillolith of the left palatine is presented. The lesion was detected incidentally during radiographic examination of a patient presenting with right mandibular pericoronitis. The patient had no symptoms referable to the left tonsillar region. Superimposition of the tonsillolith on the left mandibular ramus on panoramic radiographic examination created the false impression of an intraosseous radiopaque lesion. Many radiopaque structures and lesions occur in the soft tissues close to the jaws and are often observed on panoramic radiographs produced by imaging units with broad focal troughs. Such radiopacities in the mandibular molar-ramus region include sialolith, phlebolith, cysticercosis and calcified lymph node, carotid artery arteriosclerosis, stylohyoid ligament mineralization, and dystrophic calcification in acne scars. Tonsilloliths may present on panoramic radiograph as radiopaque objects superimposed on the midportion of the ascending mandibular ramus, and may be initially misinterpreted as intraosseous lesions of the mandible, such as foreign body, odontoma, sclerosing osteitis, Garre osteomyelitis, fibrous dysplasia, idiopathic osteosclerosis, and osteoma.