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IMAGES Table of Contents   
Year : 2001  |  Volume : 11  |  Issue : 1  |  Page : 31-32
Images : Tonsillolith

Department of Radiodiagnosis & Imaging, Kasturba Medical College, Manipal, Karnataka, India

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Keywords: Tonsillolith, Parapharyngeal Space

How to cite this article:
Shetty D, Lakhkar B, Shetty C M. Images : Tonsillolith. Indian J Radiol Imaging 2001;11:31-2

How to cite this URL:
Shetty D, Lakhkar B, Shetty C M. Images : Tonsillolith. Indian J Radiol Imaging [serial online] 2001 [cited 2020 Sep 21];11:31-2. Available from:
A sixty-seven years old man presented with a foreign body sensation in the throat for three and a half years. There was past history of repeated episodes of sore throat with fever and odynophagia since childhood. On examination the right tonsil was pushed medially. There was a swelling extending from the soft palate to the floor of the mouth on the same side.

A lateral radiograph of the neck showed a linear radio-opaque shadow overlapping the ramus of the mandible [Figure - 1] Plain CT of the face revealed a linear hyper density in the right parapharyngeal space medial to the ramus of the mandible indenting on the oropharynx [Figure - 2]

   Discussion Top

Tonsilloliths are concretions of varying size and consistency which can occur within the substance of the tonsil or from around it [1]. Repeated episodes of inflammation may produce fibrosis at the openings of the tonsillar crypts. Bacterial and epithelial debris then accumulates within these crypts and contributes to the formation of retention cysts. Calcification occurs subsequent to the deposition of inorganic salts and enlargement of the formed concretion takes place gradually [2]. The resultant calculus may be quite large and may even ulcerate through the tonsillar surface. The tonsilloliths derive their phosphate and carbonate of lime and magnesia from saliva secreted by the three major and about 400 to 500 minor salivary glands [3]. The size of the tonsillolith can vary and giant tonsilloliths have been reported in literature [4].

Tonsilloliths occur more frequently in adults than in children. Symptoms are usually non-specific such as sore throat, chronic cough or otalgia. A foreign body sensation may also exist in the back of throat with recurrent foul breath [2]. Treatment is usually removal of concretions by curretage; larger lesions may require local excision. In our patient, surgical excision was performed and a tonsillolith, which measured 7x1.5 cm in size was extracted

Differential diagnosis of tonsilloliths includes foreign body, calcified granuloma, malignancy, an enlarged styloid process or rarely, isolated bone which is usually derived from embryonic rests originating from the brachial arches [2].

   References Top

1.Samant HC, Gupta OP. Peritonsillolith. Oral Surg. 1975; 40: 56-60   Back to cited text no. 1    
2.Paparella MM, Schumrick DA. Otolaryngeology (Vo1. III-Head & Neck), 2nd ed, Philadelphia: W.B. Saunders, 1980; pp. 2275.   Back to cited text no. 2    
3.Bhaskar SN. Synopsis of Oral Pathology. St. Louis: C.V.Mosby, 1961; pp401-403.   Back to cited text no. 3    
4.Hiranandani LH. A Giant Tonsillolith. J Laryngol 1967; 81:819  Back to cited text no. 4    

Correspondence Address:
D Shetty
c/o "Anugruha", Hayagreeva Nagar, 1st Rd, Udipi 576 102, Karnataka
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[Figure - 1], [Figure - 2]

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2 An unusual tonsillolith
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