An Unusual Case of a Tonsillolith

Abstract

Tonsilloliths are rare calcified concretions that develop in tonsillar crypts within the substance of the tonsil or around it. Large tonsilloliths can mimic many conditions including abscesses or neoplasms. Given the wide range of differentials, it is difficult to diagnose tonsilloliths unless there is a considered emphasis on thorough history taking, careful inspection and a detailed characterisation of the lesion through digital palpation. This may be further supplemented with investigations such as plain radiography and computer tomography. Here, we illustrate a case with risk factors of oropharyngeal cancer and a history of fish bone impaction in the throat that was initially diagnosed as a “tonsillar foreign body” which turned out eventually to be a large tonsillolith.

Prevalence and Characteristics of Palatine Tonsilloliths in Cone Beam Computed Tomography Images: A Retrospective Study

“…Tonsilloliths are unusual calcified concretions that originates in tonsillar crypts within the substance of the tonsil or around it (2). Dystrophic calcifications may cause tonsilloliths despite normal serum calcium and phosphate levels.…”

Mandibulada Gömülü Yirmi Yaş Dişi ile İlişkili Radyopak Bir Lezyon Olarak Yanlış Teşhis Edilen Bir Tonsil Taşı

“…Tonsilloliths are most commonly seen in young adults who have a history of recurrent sore throat. 4,6,8 The sizes range from tiny undescribable radiopaque lesions, to giant tonsilloliths in the literature. 6,13,14 FIGURE 1: Panoramic radiograph revealed a radiopaque lesion related to an impacted third molar.…”

“…Tonsilloliths are believed to be formed as a consequence of the calcification, resulting from the deposition of inorganic salts within the saliva as phosphate, carbonate, calcium and magnesium. 4,5,8 Foreign bodies in the tonsillar crypts such as tablet or capsules are other possible etiological factors. 5 Tonsilloliths also play a role in the inflammation of the tonsil, by acting as a reservoir for pathogen microorganisms.…”

“…1,5,8 Garres Osteomylitis, foreign bodies, osteoma, sclerosing osteitis, idiopathic osteosclerosis, fibrous dysplasia may be misdiagnosed as radiopaque structures in the radiographs as well. 4 Dental practitioners have to be aware of these ghost images and the possibility of superimpositions on panoramic radiographs, as they cause misinterpretations. In order to prevent such misinterpretations, the possibility of the existence of tonsilloliths should always be considered during the process of differential diagnosis of the lesions in this region.…”

“…8,11 The occurence of tonsilloliths are reported equally in both genders. 3,4 They may be discovered accidentally in routine panoramic radiographs. 5,8,12 Tonsilloliths are easily misdiagnosed because of their radiopaque appereance on radiographs.…”