A giant tonsillolith

It is not so uncommon to find small concretions in the
tonsil, but a well formed giant tonsillolith is
comparatively rare.Symptoms include throat pain ,odynophagia ,referred otlgia.

1. A Giant Tonsillolith Dr Shrikant Phatak Head of ENT Department Choithram Hospital & Research Center Indore

2. Tonsillolith Tonsillolith is a well recognised clinical entity, yet only a few cases of lithiasis in the t onsils have been reported. It is not so uncommon to find small concretions in the tonsil, but a well formed giant tonsillolith is comparatively rare . Tonsilloliths or calculi of the tonsil are calcifications that form in the crypts of the palatine tonsil or around it.

3. Tonsillolith The commonest accepted hypothesis is that Tonsilloliths form from retained caseous secretions in the tonsillar crypts in conjunction with filaments of leptothrix buccalis – a common oral saprophyte,sometimes in association with chronic purulent tonsillitis

4. Tonsillolith Causation The etiopathogenesis of tonsillolith, is still uncertain. It is postulated that chronic tonsillitis associated with repeated episodes of inflammation produce fibrosis of the openings of the tonsillar crypts followed by accumulation of bacterial and epithelial debris in these crypts leading to the formation of retention cysts. Calcification occurs subsequent to the deposition of inorganic salts following which gradual enlargement of the concretion takes place .

5. Symptoms Small concretions are asymptomatic while large Calculi can cause symptoms such as sore throat and referred otalgia. A foreign body sensation and halitosis may also be presenting symptoms. It is not unusual for tonsillolith to be diagnosed on routine radiological studies. Large calculi are clinically seen as a hard mass in the tonsil

6. Tonsillolith : Composition A mineralogical analysis of the tonsillolith reveals primarily carbonates and / or phosphates of calcium but other minerals like magnesium, sodium, silica, potassium, ammonium radicals, copper, aluminium, iron have also been reported.

7. Treatment consists of surgical removal of the stone. Tonsillectomy isindicated if the calculi are embedded in the tonsillar tissue or when associated with chronic tonsillitis.

8. Tonsillolith A 23 years old female presented with symptoms of repeated Right sided throat pain. On examination yellowish stony mass seen in the Right Tonsil. It was hard on palpation. Neck nodes were not palpable. Blood investigations were normal. CECT Neck was done. Tonsillolith was removed under General Anaesthesia Yellowish stony mass in right tonsil

9. Tonsilolith CT Scan Radioopaque shadow in Right Tonsil Removed tonsiollith

10. Disclaimer The information contained in the presentation is based on the personal experience and cases collected at Choithram Hospital Indore over the last 20 years. It is intended for the use of Medical students ENT post graduates. The views expressed are purely on personal opinion. viewers can make their own opinion. For any confusion please contact sole author. Everybody is allowed to copy or download the material best suited to him. I am not responsible for any controversies arising out of the presentation. For any suggestions or corrections you may please contact [email protected]

11. Tonsillolith Thank you