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Kaleemullah S, Alokkan J, Swathi R, Viswanatha B. Prevalence of Tonsilloliths in Chronic Rhinosinusitis: A Retrospective CT PNS Study. Indian J Otolaryngol Head Neck Surg 2024; 76:84-87. [PMID: 38440553 PMCID: PMC10908942 DOI: 10.1007/s12070-023-04087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/12/2023] [Indexed: 03/06/2024] Open
Abstract
To determine the prevalence of tonsilloliths in CT PNS (Computed Tomography ParaNasal Sinuses) of patients with and without features of chronic rhinosinusitis. 97 CT PNS of the patients with features of chronic rhinosinusitis were included in the study group, and 124 CT PNS of cases without features of chronic rhinosinusitis were taken as the control group. All 221 CT PNS were then evaluated for the presence of tonsillar calcifications indicative of tonsilloliths and the prevalence of the same in the study and control groups. 97 of the 221 CT PNS evaluated showed features of chronic rhinosinusitis. 60 of these 97 CT PNS showed features of tonsillolith in one or both tonsils. Of these 60 cases, 58 had maxillary sinusitis, and 17 had pansinusitis. Most of the cases had small tonsilloliths (1-3 mm), and only one case had a large tonsillolith (> 6 mm). At the same time, 27 out of the remaining 124 CT PNS without chronic rhinosinusitis showed the presence of tonsilloliths in one or both tonsils. The prevalence of tonsilloliths is significantly higher in patients with chronic rhinosinusitis than in the control group. The presence of tonsilloliths in patients with chronic rhinosinusitis indicates repeated inflammation of the tonsils due to sinusitis. Such chronic inflammation of the mucosa of the pharynx should prompt more aggressive treatment of chronic rhinosinusitis.
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Affiliation(s)
- S. Kaleemullah
- Department of Radiodiagnosis, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - Jolene Alokkan
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - R. Swathi
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
| | - B. Viswanatha
- Department of Otorhinolaryngology, East Point College of Medical Sciences and Research Centre, Bangalore, India
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Prevalence of palatine tonsilloliths in Dominican patients of varying social classes treated in university clinics. Sci Rep 2020; 10:1679. [PMID: 32015463 PMCID: PMC6997381 DOI: 10.1038/s41598-020-58675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/19/2020] [Indexed: 11/08/2022] Open
Abstract
The relevance of tonsils lies not only in local but also in systemic immunity. One of the most common ailments afflicting the tonsils are palatine tonsilloliths (PT), dystrophic calcifications found in the tonsillar crypts. PT prevalence reports have been conducted for Caucasian and Asian patients, but not for black patients. The aim of this cross-sectional study is to gauge the prevalence of PT in patients who sought treatment at two university clinics in the Dominican Republic, and to analyze any links with the race of patients. Two hundred and nine consecutive patients attending the dental services of two clinics located in different cities in the Dominican Republic, from March 1 to April 30, 2019, were selected. Computed tomography scans of patients were evaluated for a PT diagnosis. Determined prevalence of PT in this population sample was 5.85%. A non-significant relationship between occurrence of PT and race or kind of health service utilized was found. Nonetheless, more white patients used private health clinics while more black patients used the public health system. Previous tonsillitis was the only factor showing a significant correlation with the occurrence of PT. Also, PT prevalence was significantly higher in patients under 40 years of age. General prevalence of PT was significantly lower than reported in previous studies involving other countries/races. Considering the limitations of this study, when comparing it to a previous similar study and taking into account the Asian- and Caucasian-centric results obtained, a race influence on prevalence of calcifications may be suggested. Despite our results showing no racial differences within the Dominican Republic, black patients appear to present a lower prevalence of PT than Caucasian and Asian patients.
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Ozdede M, Akay G, Karadag O, Peker I. Comparison of Panoramic Radiography and Cone-Beam Computed Tomography for the Detection of Tonsilloliths. Med Princ Pract 2020; 29:279-284. [PMID: 31842016 PMCID: PMC7315145 DOI: 10.1159/000505436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A tonsillolith is a concretion of the tonsillar crypt. The aim of this retrospective study was to compare panoramic radiography (PR) and cone-beam computed tomography (CBCT) for the detection of tonsilloliths. MATERIALS AND METHODS The CBCT images of 527 patients with maxillofacial volume were evaluated retrospectively. Of these, 175 patients (81 females, 94 males; mean age 51.05 years) had unilateral or bilateral tonsilloliths. In total, 151 of them (67 females, 84 males; mean age, 51.03 years) had PR images performed in the same period and were included in the study. The PR images were examined to ascertain whether known tonsilloliths (from CBCT images) could be detected. The location (unilateral; left or right and bilateral), size, and number of the tonsilloliths were examined on both CBCT and PR images. Descriptive analysis, Spearman's rho correlation coefficient, and χ2 tests were used for the statistical analysis. RESULTS The detection rate of tonsillolith was 33.2% on CBCT images. Only 51.4% of the tonsilloliths detected on CBCT were evaluated by PR; the correlation between CBCT and PR was found to be significant (Spearman's r = 0.399, p = 0.000). PR was not adequate to detect tonsilloliths 1 mm or smaller in size. All the calcifications larger than 5 mm were detected on PR images. CONCLUSION The results of this study showed that more than half of the tonsilloliths observed in CBCT were also detected in PR. Tonsilloliths larger than 2 mm were more likely to be detected on PR images.
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Affiliation(s)
- Melih Ozdede
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey,
| | - Gulsun Akay
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Ozge Karadag
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Ilkay Peker
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Kalabalık F, Çiftçi C, Aytuğar E. Investigation of the Prevalence of Tonsillolith in the Aegean Region Using Cone-Beam Computed Tomography. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2019. [DOI: 10.30934/kusbed.585147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schafer DR, Glass SH. A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology. Head Neck Pathol 2019; 13:33-46. [PMID: 30693453 PMCID: PMC6405798 DOI: 10.1007/s12105-018-0977-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022]
Abstract
When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.
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Affiliation(s)
- Duane R. Schafer
- 0000 0004 0386 9246grid.267301.1University of Tennessee Health Sciences Center College of Dentistry, Memphis, TN USA
| | - Sarah H. Glass
- 0000 0004 0458 8737grid.224260.0Virginia Commonwealth University School of Dentistry, Richmond, VA USA
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Takahashi A, Sugawara C, Akita K, Kamada K, Kudoh K, Tamatani T, Miyamoto Y. Prevalence and imaging characteristics of nasopharyngeal and eustachian tube tonsilloliths in 2244 patients determined using computed tomography. Dentomaxillofac Radiol 2018; 47:20180052. [PMID: 29714075 DOI: 10.1259/dmfr.20180052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: Nasopharyngeal tonsilloliths (NT) and eustachian tube tonsilloliths (ET) are not as well-known to radiologists as palatine and lingual tonsilloliths. The aim of this investigation was to determine the prevalence and imaging characteristics of NT and ET using CT and panoramic radiographs. METHODS: We retrospectively assessed the scans of 2244 patients who underwent consecutive CT and panoramic radiographs of the maxillofacial region. The prevalence, size, number, and position of NT and ET were analysed. RESULTS: NT and ET were detected in 14 (0.6%) and 6 (0.3%) of 2244 patients on CT, respectively, but they were undetectable on panoramic radiographs. No significant difference was found in the prevalence with respect to sex. Although there was also no significant difference in the prevalence among age groups, tonsilloliths were most commonly noted in patients over 40 years old; they appeared as small and round calcified bodies, ranging from 1 to 3 mm in diameter. All NT were found 0 to 3 mm beneath the nasopharyngeal mucosal surface. CONCLUSIONS: The prevalence of NT and ET on CT was lower than that of palatine and lingual tonsilloliths. However, since they are encountered more frequently than clinically significant calcifying diseases such as retropharyngeal calcific tendinitis, clinicians should be able to correctly diagnose NT and ET based on their anatomical features.
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Affiliation(s)
- Akira Takahashi
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Chieko Sugawara
- 2 Department of Oral Surgery, Tokushima Prefectural Central Hospital , Tokushima , Japan
| | - Kazuya Akita
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kumiko Kamada
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Keiko Kudoh
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Tetsuya Tamatani
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Youji Miyamoto
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
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Diener VN, Gay A, Soyka MB, Attin T, Schmidlin PR, Sahrmann P. What is the influence of tonsillectomy on the level of periodontal pathogens on the tongue dorsum and in periodontal pockets. BMC Oral Health 2018; 18:62. [PMID: 29625605 PMCID: PMC5889595 DOI: 10.1186/s12903-018-0521-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND For periodontal treatment, the full mouth disinfection approach suggests disinfection of oral soft tissues, such as tongue and tonsils concomitant to scaling and root planning since patients might benefit from treatment of these oral niches either. Periodontopathogenes in tonsillar tissue support this hypothesis. This prospective controlled clinical study investigated the change in the oral flora of patients who underwent tonsillectomy. Pockets were tested for eleven bacterial species before and six weeks after the surgical intervention. METHODS Fifty generally healthy adults were included in this study. The test group consisted of 25 patients with tonsillectomy. The control group included 25 patients with otorhinolarynologic surgery without involvement of the oral cavity. Clinical parameters such as probing pocket depth, bleeding-on-probing index and plaque index were registered the evening before surgery. Also bacterial samples from the gingival sulcus and dorsum linguae were taken, and an additional sample from the removed tonsils in the test group. Six weeks after the intervention microbial samples of pockets and tongue were taken again. Data were tested for significant differences using Wilcoxon rank and Whitney-u-test. RESULTS No relevant intra- or intergroup differences were found for the change of the eleven investigated species. CONCLUSION Based on the results of the present study, tonsillectomy does not seem to have an immediate relevant effect on the bacterial flora of tongue or periodontium. This study design was approved by the ethical committee of Zurich (KEK-ZH-Nr.2013-0419). TRIAL REGISTRATION The trial was retrospectively registered in the German Clinical Trials Register ( DRK00014077 ) on February 20, 2018.
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Affiliation(s)
- V N Diener
- Clinic for Preventive Dentistry, Periodontology and Cariologiy, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - A Gay
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M B Soyka
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - T Attin
- Clinic for Preventive Dentistry, Periodontology and Cariologiy, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P R Schmidlin
- Clinic for Preventive Dentistry, Periodontology and Cariologiy, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P Sahrmann
- Clinic for Preventive Dentistry, Periodontology and Cariologiy, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Kim MJ, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Multidetector computed tomography imaging characteristics of asymptomatic palatine tonsilloliths: a retrospective study on 3886 examinations. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:693-698. [PMID: 29506917 DOI: 10.1016/j.oooo.2018.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/19/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of palatine tonsilloliths and analyze their multidetector computed tomography (CT) imaging features. STUDY DESIGN The CT images of 3886 patients (1654 men, 2232 women; mean age, 35.8 years) were reviewed. The distribution, dimension, morphology, and location of each tonsillolith was assessed. The correlation between participant demographic characteristics and the characteristics (prevalence, number, size) of tonsilloliths was determined. RESULTS The prevalence of palatine tonsilloliths was 30.3%; we identified significant differences in the prevalence and size between men and women. The prevalence of tonsilloliths significantly increased with age (P < .001). The mean number of tonsilloliths per participant was 2.7, and 64.7% of patients had 1 to 2 tonsilloliths. Ovoid-shaped tonsilloliths were the most common (approximately 80%). The centers of the tonsillar crypts contained the majority of the tonsilloliths, 50.3% of which had sizes of 1 to 2 mm. CONCLUSION The results, based on a larger sample size compared with previous studies, can be applied as guidelines for the diagnosis of tonsilloliths on CT images.
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Affiliation(s)
- Mi-Jin Kim
- School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Takahashi A, Sugawara C, Kudoh K, Yamamura Y, Ohe G, Tamatani T, Miyamoto Y. Lingual tonsillolith: prevalence and imaging characteristics evaluated on 2244 pairs of panoramic radiographs and CT images. Dentomaxillofac Radiol 2017; 47:20170251. [PMID: 28937280 DOI: 10.1259/dmfr.20170251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Lingual tonsilloliths are not as well-known to radiologists than palatine tonsilloliths, although they might be common in clinical practice. The aim of this investigation was to clarify the prevalence and imaging characteristics of lingual tonsilloliths using panoramic radiographs and CT images. METHODS This study included 2244 patients without pathology at the base of tongue who had undergone panoramic radiography and CT of the maxillofacial region. The size, number and position of lingual tonsilloliths relative to the mandible and tongue were evaluated. RESULTS Lingual tonsilloliths were observed in 33 (1.5%) and 108 (4.8%) of all patients on panoramic radiographs and CT images, respectively. The prevalence was higher in patients aged ≥40 years than in those aged < 40 years (χ2, p < 0.01). They appeared as small, round- or rod-shaped calcified bodies, and they always located closely anterior (1-17 mm) to the anterior border of oropharyngeal airway on panoramic radiographs. Lingual tonsilloliths were superimposed over the surrounding soft tissue inferior to the body of the mandible, posteroinferior to the angle of the mandible and posterior to the mandible in 16 (48.5%), 15 (45.5%) and 1 (3.0%) individual, respectively. A significant correlation was observed between the detectability on panoramic radiographs and size (Spearman's r = 0.961, p < 0.01) of tonsilloliths, as revealed by CT images. CONCLUSION Lingual tonsilloliths commonly appear on CT. They also appear on panoramic radiography and may superimpose the surrounding soft tissue of the mandible. Although lingual tonsilloliths may resemble other pathological calcifications including submandibular sialoliths and lingual osseous cholistoma, they can be differentiated by carefully observing panoramic radiographs. When clinicians detect calcified bodies near the base of tongue, lingual tonsilloliths should be included in the differential diagnoses.
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Affiliation(s)
- Akira Takahashi
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Chieko Sugawara
- 2 Department of Oral Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Keiko Kudoh
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshiko Yamamura
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Go Ohe
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuya Tamatani
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Youji Miyamoto
- 1 Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Takahashi A, Sugawara C, Kudoh T, Ohe G, Takamaru N, Tamatani T, Nagai H, Miyamoto Y. Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images. Clin Oral Investig 2016; 21:85-91. [PMID: 26892471 DOI: 10.1007/s00784-016-1752-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Palatine tonsilloliths incidentally detected on diagnostic imaging should be differentiated from pathologic calcifications to enable correct diagnosis and treatment. The aim of this study is to clarify the prevalence and imaging characteristics of palatine tonsilloliths on panoramic radiographs. MATERIALS AND METHODS We retrospectively reviewed 2244 individuals who underwent pairs of consecutive panoramic radiography and computed tomography (CT) of the head and neck region. The imaging characteristics of palatine tonsilloliths on panoramic radiography were compared with the findings from CT, which was considered the gold standard. RESULTS Tonsilloliths were detected in 300 (13.4 %) and 914 (40.7 %) of the 2244 individuals on panoramic radiographs and CT, respectively. On panoramic radiographs, tonsilloliths were superimposed over the ramus of the mandible at the level coincident with and inferior to the soft palate in 176 (7.8 %) and 90 (4.0 %) individuals, respectively. Tonsilloliths were also superimposed over the surrounding soft tissue inferior to the body of the mandible, postero-inferior to the angle of the mandible, and posterior to the ramus of the mandible in 33 (1.5 %), 26 (1.2 %), and 28 (1.3 %) individuals, respectively. A significant correlation was observed between the detectability on panoramic radiographs and the size (Spearman r = 1.000) and number (Spearman r = 0.991) of tonsilloliths, as revealed by CT images. CONCLUSIONS The present results suggest that tonsilloliths are commonly detected on panoramic radiographs. Furthermore, they can be superimposed on both the mandible and the surrounding soft tissue. CLINICAL RELEVANCE Clinicians should include tonsilloliths among the differential diagnoses when calcified bodies are detected on panoramic radiographs.
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Affiliation(s)
- Akira Takahashi
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan.
| | - Chieko Sugawara
- Department of Comprehensive Dentistry, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takaharu Kudoh
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
| | - Go Ohe
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
| | - Natsumi Takamaru
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
| | - Tetsuya Tamatani
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
| | - Hirokazu Nagai
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
| | - Youji Miyamoto
- Department of Oral Surgery, Oral Sciences, Clinical Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8504, Japan
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