IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Bilateral palatine tonsilloliths on OPG and CT

Case contributed by Craig Hacking
Diagnosis certain

Presentation

2 weeks history of protruding bone from left lower posterior jaw and medial edge. Very sharp bone felt on palpation, extruding minimally from joint line. Query fracture or abscess or abnormal bone growth.

Patient Data

Age: 75 years
Gender: Female

Projected over the left angle and ramus of the mandible, there are multiple small round nodular calcific foci. No cortical destruction, periosteal reaction or endosteal scalloping of the mandible. Ghost shadowing is noted across the image from some of the calcifications indicating they are outside the focal trough.

Multiple teeth are absent from all four quadrants and there has been previous dental restorations.

Innumerable bilateral palatine punctate calcifications are demonstrated in keeping with tonsilloliths. Both parotid glands are normal in appearance. Parapharyngeal spaces are clear. 

No bony lesion of the mandible to explain the patient's symptoms.

Case Discussion

The OPG was initially interpreted as possible calcific foci in the parotid glands, leading to the CT. OPG features are typical for bilateral palatine tonsilloliths. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.