Bilateral palatine tonsilloliths on OPG and CT

Case contributed by Assoc Prof Craig Hacking


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. 

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