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
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.