Tonsillolith

Introduction: Tonsillolith is a rare dystrophic calcification occuring in the tonsil as a result of chronic inflammation. Most commonly tonsilloliths are intratonsillar and are asymptomatic. They have been identified incidentally. Commonly patients with tonsillolith complain of foul breath and throat pain. Throat pain is usually very intense during acts of swallowing. Also known as tonsil concretions or tonsillar stones.

Deposition of calcium salts (Calcium phosphate) occurs normally in the skeleton. When calcification occurs in soft tissues in an unorganized fashion it is known as heterotopic calcification. Calcium salts (Calcium phosphate) occurs normally in the skeleton. When calcification occurs in soft tissues in an unorganized fashion it is known as heterotopic calcification. This heterotopic calcification can be further subdivided into three categories:

Metastatic calcification: This calcification occurs in normal tissues due to deposition of calcium. This is the result of higher than normal levels of serum calcium as in the case of hyperparathyroidism or higher levels of serum phosphate as in patients with chronic renal failure. Metastatic calcification usually occurs bilaterally and symmetrically.

Idiopathic calcification: This condition refers to deposition of calcium in normal tissue despite normal serum levels of calcium and phosphate. Examples include chondrocalcinosis and phleboliths.

Dystrophic calcification: Is pathologic and usually occurs in degenerative and dead tissues. This calcification occurs despite normal serum calcium and phosphate levels.

Pathogenesis: Largely remains unknown. It has been commonly attributed to be due to recurrent infections involving the tonsillar tissue. It can also occur due to obstruction to the largest tonsillar crypt (Crypta magna) causing inspisated secretions to accumulate within the crypt causing it to undergo calcification. Another possibility could be due to obstruction to the ducts of accessory salivary glands (Weber's glands) causing it to calcify. This obstruction is possible due to the formation of scar tissue following tonsillectomy or infection.

Clincial features:

1. Commonly asymptomatic

2. Halitosis

3. Pain in the throat

4. Cervical adenopathy usually involving the upper deep cervical nodes

Tonsillolith may occur in any age group. Tonsilloliths are usually hard in consistency, may be single or multiple, may be round or oval, cylinderical or irregular pyramidal shape.

Management:

Usually unilateral tonsillectomy is indicated in these patients. Spontaneous extrusion of tonsilloliths have also been reported.

You can view the surgical clipping from here.

Histopathology:

Microscopic examination of the tonsillolith shows necrotic debris, ghost cells, calcifications and

inflammatory cells.

Composition of tonsillolith:

Usually tonsillolith contains minerals like carbonates and phosphonates of calcium. Other minerals like magnesium, sodium, silica, potassium, ammonia have been reported.

Image showing a tonsillolith in the superior pole of right tonsil