Bilateral and pseudobilateral tonsilloliths: Three dimensional imaging with cone-beam computed tomography

Area of Science:

• Dentistry
• Radiology
• Oral and Maxillofacial Surgery

Background:

• Tonsilloliths are calcifications within palatal tonsil crypts.
• They are often incidentally found on panoramic radiographs.
• Distinguishing true bilateral tonsilloliths from artifactual images can be challenging.

Purpose of the Study:

• To evaluate the diagnostic benefits of cone-beam computed tomography (CBCT) for tonsilloliths.
• To assess CBCT's ability to differentiate true bilateral tonsilloliths from pseudoimages on panoramic radiographs.

Main Methods:

• Seven patients with bilateral radiopaque lesions on panoramic radiographs were included.
• CBCT scans were used to determine the exact location and nature of the lesions.
• Semiautomatic segmentation software was employed to measure calcification volume.

Main Results:

• CBCT revealed unilateral lesions in 2 cases initially appearing bilateral on panoramic views.
• Total calcification volumes ranged from 7.92 to 302.5 mm³.
• Symptomatic patients presented with multiple and large bilateral calcifications.

Conclusions:

• Tonsilloliths should be considered in the differential diagnosis of mandibular ramus radiopacities.
• CBCT is essential for differentiating true bilateral tonsilloliths from artifactual images.
• Accurate diagnosis impacts patient management and understanding of symptomatic calcifications.