Tonsillolith: A Panoramic Radiograph Presentation

Case RepoRt A 55-year-old male patient signed in for replacement of his edentulous space by implants. Most of his maxillary and mandibular teeth had got exfoliated because of periodontitis and the patient was edentulous for around 8-10 years. He had now visited us for replacement of teeth. A panoramic radiograph was made in which showed as an incidental finding of multiple bilateral radiopacites on the mid portion of right and left mandibular ramus, in the region where the image of the dorsal surface of the tongue crossed the ramus in the palatoglossal air spaces, was seen. These radiopacites were multiple, small and well defined and they were approximately around 2 mm in diameter [Table/Fig–1,2 and 3]. These calcifications had densities which were slightly more than those of the cancellous bone. The average size of these radiopacites was around 3 mm in diameter, which overlapped the foramen of the right mandible ramus. A probable diagnosis of calcification in the soft tissues was made although the pos sibility of an intra-osseous abnormality was not ignored. Later, a retrograde, detailed, clinical examination of the patient was done. His medical history revealed that the patient was in excellent health, with no history of any systemic disease. Tissues which were related to the parotid-mesenteric areas were clinically painless and normal in tone when they were palpated. Cervical lymphadenopathy and trismus were absent. Intraorally, maxillary arch was edentulous and lower arch was partially edentulous, with 34, 35, 37, 43, 44 and 47, which were endodonticaly treated and for which crowns were placed. No other pathological intra-oral findings were observed. Considering the radiographic location and appearance of the lesion on an orthopantomograph, diagnosis of the Tonsillolith was made. An ENT consultation was given, which did not reveal any positive signs of pathology on clinical examination. As the patient was asymptomatic and as the tonsiloliths were multiple and small, no specific treatment was given.