Tonsillolith

Abstract: The scans of 100 consecutive patients referred for computed tomographic examinations that included the oropharynx were reviewed with regard to calcifications of the palatine tonsillary region. Calcifications were found in 20% of the female patients and 13% of the male patients. Ten patients had one calculus, and six had two or more. The sizes of the calculi ranged from 1 to 7 mm. Tonsillary calculi must be included among the diagnostic possibilities when survey radiographs of the neck show soft-tissue calcifications.

Abstract: Objective To study the volatile sulphur compounds (VSC) halitometry profile in a population with chronic caseous tonsillitis (CCT) and halitosis and to evaluate the relationship between the presence of a tonsillolith and abnormal halitometry in this population. Design Clinical prospective non-randomised study. Subjects and methods Forty-nine patients with halitosis and CCT, 17 male (35%) and 32 female (65%), were selected among patients referred for CO2 laser cryptolysis. Anamnesis, physical examination and VSC halitometry were carried out. Halitometry values less than 150 ppb of VSC were considered normal. Results Patients were divided in two groups: Group A – normal halitometry (41 patients – 83.7%) and Group B – abnormal halitometry (8 patients – 16.3%). Halitometry results in Group B were 5.2 times (429%) higher than in Group A and the majority of the patients with abnormal halitometry presented with a tonsillolith at the moment of examination. A tonsillolith was present in 75% of the patients with abnormal halitometry and only 6% of patients with normal halitometry values. Conclusions The presence of a tonsillolith represents a tenfold increased risk of abnormal VSC halitometry and can be considered as a predictable factor for abnormal halitometry in patients with CCT.

Abstract: Tonsillolith is a rare dystrophic calcification as a result of chronic inflammation of the tonsils. Three asymptomatic cases of tonsillolith are reported, incidentally discovered through panoramic radiographs, which showed different sizes of radiopaque images, varying from 2 to 5mm; cases I and III images did not overlap the mandible ramus, which led to a probable diagnosis of soft tissue calcification. Case II had radiopaque unilateral images, with osseous tissue density, overlapping the mandibular ramus, leading to a benign intra-osseous lesion, which was considered as differential diagnosis. No symptoms were reported in any case. Only case I had clinical characteristics, showing highly consistent white plaques partially visible through the mucosa. Computed tomography of the maxillofacial region/head and neck were requested to find out the exact location of these images, since most of the overlapping radiopaque images in the mandibular ramus were very similar to intra-osseous abnormalities. The computed tomography showed hyperdense images in the palatine tonsils, confirming the diagnosis of tonsillolith. The patients are currently under follow-up. No treatment is required if there is no symptom. In conclusion, tonsillolith might show images on panoramic radiographs similar to intra osseous abnormalities. The diagnosis is relatively easy when computed tomography is requested, although the images are not pathognomonic. Therefore, clinicians should consider other pathologies as differential diagnosis.