Neuroradiology Case of the Week

Case 43

Dov M. Almog, DMD, and P-L Westesson, MD, PhD, DDS

Clinical Presentation: Patient had mandibular pain on the left side. Panoramic radiograph was obtained to assess for oral, maxillofacial and dental disease.

Radiological Findings: No dental disease was identified. There is a 1.5 cm irregular
calcification projecting over the ramus on the right side.

Figure 1

Diagnosis: Tonsilar calcification.

Discussion:
   The tonsils are defined as a collection of lymphoid tissue covered by mucous membranes located in several different areas on either side of the throat.
   Tonsilar calcifications are fairly commonly seen. They are usually secondary to old infections. In this patient there is a large calcification on the right side and a cluster of smaller similar calcification are seen on the left side.
   The lesion was detected incidentally during radiographic examination of a patient presenting for a periodontal consult. Superimposition of the calcifications on the right and left midportion of the ascending mandibular ramus on panoramic radiographic examination created the false impression of an intraosseous radiopaque lesion. Many radiopaque structures and lesions occur in the soft tissues close to the jaws and are often observed on panoramic radiographs produced by imaging units with broad focal troughs. Such radiopacities in the mandibular molar-ramus region include sialolith, phlebolith, calcified lymph nodes, carotid artery arteriosclerosis, odontoma, sclerosing osteitis, Garre osteomyelitis, fibrous dysplasia, idiopathic osteosclerosis, osteoma, stylohyoid ligament mineralization, and dystrophic calcification in acne scars.

References:

1. Marshall WG, Irwin ND. Tonsilloliths. Oral Surg Oral Med Oral Pathol. 1981 Jan;51(1):113.
2. Thomas DP. Tonsilloliths--a common cause of pharyngeal calcification. Australas Radiol. 1974 Sep;18(3):287-91.