Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Bilateral and pseudobilateral tonsilloliths: Three dimensional imaging with cone-beam computed tomography

  • Misirlioglu, Melda (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University) ;
  • Nalcaci, Rana (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University) ;
  • Adisen, Mehmet Zahit (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University) ;
  • Yardimci, Selmi (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University)
  • Received : 2012.12.05
  • Accepted : 2013.03.15
  • Published : 2013.09.30
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Abstract

Purpose: Tonsilloliths are calcifications found in the crypts of the palatal tonsils and can be detected on routine panoramic examinations. This study was performed to highlight the benefits of cone-beam computed tomography (CBCT) in the diagnosis of tonsilloliths appearing bilaterally on panoramic radiographs. Materials and Methods: The sample group consisted of 7 patients who had bilateral radiopaque lesions at the area of the ascending ramus on panoramic radiographs. CBCT images for every patient were obtained from both sides of the jaw to determine the exact locations of the lesions and to rule out other calcifications. The calcifications were evaluated on the CBCT images using Ez3D2009 software. Additionally, the obtained images in DICOM format were transferred to ITK SNAP 2.4.0 pc software for semiautomatic segmentation. Segmentation was performed using contrast differences between the soft tissues and calcifications on grayscale images, and the volume in mm3 of the segmented three dimensional models were obtained. Results: CBCT scans revealed that what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions in 2 cases. The total volume of the calcifications ranged from 7.92 to $302.5mm^3$. The patients with bilaterally multiple and large calcifications were found to be symptomatic. Conclusion: The cases provided the evidence that tonsilloliths should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and they highlight the need for a CBCT scan to differentiate pseudo- or ghost images from true bilateral pathologies.

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References

  1. Silvestre-Donat FJ, Pla-Mocholi A, Estelles-Ferriol E, Martinez- Mihi V. Giant tonsillolith: report of a case. Med Oral Patol Oral Cir Bucal 2005; 10: 239-42.
  2. Neville B, Damm DD, Allen CM, Bouquot J. Oral & maxillofacial pathology. 2nd ed. Philadelphia: WB Saunders; 2002.
  3. Mesolella M, Cimmino M, Di Martino M, Criscuoli G, Albanese L, Galli V. Tonsillolith. Case report and review of the literature. Acta Otorhinolaryngol Ital 2004; 24: 302-7.
  4. Ram S, Siar CH, Ismail SM, Prepageran N. Pseudo bilateral tonsilloliths: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 110-4 https://doi.org/10.1016/j.tripleo.2003.11.015
  5. Ozcan E, Ural A, Oktemer TK, Alpaslan G. Bilateral tonsillolithiasis: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: e17-8. https://doi.org/10.1016/j.tripleo.2006.01.010
  6. Sezer B, Tugsel Z, Bilgen C. An unusual tonsillolith. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95: 471-3. https://doi.org/10.1067/moe.2003.65
  7. Lo RH, Chang KP, Chu ST. Upper airway obstruction caused by bilateral giant tonsilloliths. J Chin Med Assoc 2011; 74: 329-31. https://doi.org/10.1016/j.jcma.2011.05.011
  8. Poeschl PW, Schmidt N, Guevara-Rojas G, Seemann R, Ewers R, Zipko HT, et al. Comparison of cone-beam and conventional multislice computed tomography for image-guided dental implant planning. Clin Oral Investig 2013; 17: 317-24. https://doi.org/10.1007/s00784-012-0704-6
  9. Pauwels R, Beinsberger J, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, et al. Comparison of spatial and contrast resolution for cone-beam computed tomography scanners. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114: 127-35. https://doi.org/10.1016/j.oooo.2012.01.020
  10. Guevara C, Mandel L. Panoramic radiographic demonstration of bilateral tonsilloliths. N Y State Dent J 2011; 77: 28-30.
  11. White SC, Pharoah MJ. Oral Radiology: principles and interpretation. 5th ed. St. Louis: Mosby; 2004.
  12. Yasuda CL, Costa AL, Franca M Jr, Pereira FR, Tedeschi H, de Oliveira E, et al. Postcraniotomy temporalis muscle atrophy: a clinical, magnetic resonance imaging volumetry and electromyographic investigation. J Orofac Pain 2010; 24: 391-7.
  13. Cevidanes LH, Styner MA, Proffit WR. Image analysis and superimposition of 3-dimensional cone-beam computed tomography models. Am J Orthod Dentofacial Orthop 2006; 129: 611-8. https://doi.org/10.1016/j.ajodo.2005.12.008
  14. Cevidanes LH, Bailey LJ, Tucker GR Jr, Styner MA, Mol A, Phillips CL, et al. Superimposition of 3D cone-beam CT models of orthognathic surgery patients. Dentomaxillofac Radiol 2005; 34: 369-75. https://doi.org/10.1259/dmfr/17102411
  15. Cooper MM, Steinberg JJ, Lastra M, Antopol S. Tonsillar calculi. Report of a case and review of the literature. Oral Surg Oral Med Oral Pathol 1983; 55: 239-43. https://doi.org/10.1016/0030-4220(83)90320-1
  16. Marshall WG, Irwin ND. Tonsilloliths. Oral Surg Oral Med Oral Pathol 1981; 51: 113. https://doi.org/10.1016/0030-4220(81)90135-3
  17. de Moura MD, Madureira DF, Noman-Ferreira LC, Abdo EN, de Aguiar EG, Freire AR. Tonsillolith: a report of three clinical cases. Med Oral Patol Oral Cir Bucal 2007; 12: 130-3.
  18. Almog DM, Horev T, Illig KA, Green RM, Carter LC. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 768-73. https://doi.org/10.1067/moe.2002.128965
  19. Fanibunda K, Lovelock DJ. Calcified stylohyoid ligament: unusual pressure symptoms. Dentomaxillofac Radiol 1997; 26: 249-51. https://doi.org/10.1038/sj.dmfr.4600246
  20. Ravon NA, Hollender LG, McDonald V, Persson GR. Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results. J Clin Periodontol 2003; 30: 1084-90. https://doi.org/10.1046/j.0303-6979.2003.00427.x

Cited by

  1. Palatine Tonsilloliths: A Retrospective Study on 500 Digital Panoramic Radiographs vol.19, pp.10, 2013, https://doi.org/10.5005/jp-journals-10024-2418
  2. Comparison of Panoramic Radiography and Cone-Beam Computed Tomography for the Detection of Tonsilloliths vol.29, pp.3, 2013, https://doi.org/10.1159/000505436