Ct imaging characteristics of asymptomatic tonsilloliths

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CT imaging characteristics of asymptomatic tonsilloliths
Soon-Chul Choi, Mi-Jin Kim, Jo-Eun Kim, Kyung-Hoe Huh, Sam-Sun Lee

Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University

Introduction and Objectives

Tonsilloliths are commonly encountered in clinics. Because patients rarely have complaints of symptoms, tonsilloliths are accidently detected on images. Purpose of this research is studying prevalence of tonsilloliths and analyzing characteristic features using CT images.


The CT images of 3886 patients (1654 male, 2232 female; mean age 35.8 years) at the Seoul National University Dental Hospital from January 1, 2012 to December 31, 2012 were reviewed. For the patients presenting tonsilloliths, we classified the distribution of tonsilloliths into unilateral or bilateral, right or left and clustered or dispersed. For each tonsillolith, we analyzed the size, morphology (sphere, ovoid, plurilobular, rod, and amorphous), and relative location in tonsil (total 27 areas, 3 even parts in 3 way; anterior to posterior, medial to lateral, superior to inferior). Lastly, we verified the correlation between the characteristics of tonsilloliths (prevalence, number, size) and the information of patients (age, sex) .

Results and Discussion

Prevalence of tonsilloliths was 30.3% and male (33.3%) presented higher prevalence than female (28.2%). The prevalence of tonsilloliths increased as the age of patients increased with significance (p<0.001). The 64.7% of patients had 1-2 tonsilloliths and mean number of tonsilloliths was 2.7. The 50.3% of calculus had size of 1-2 mm. On average, male had more and larger tonsilloliths than female with significant differences (p<0.001). Unilateral tonsilloliths (66.8%) were more frequently observed than bilateral types (33.2%), and differences between left and right for unilateral tonsilloliths were not significant. Ovoid shaped tonsillolith was the most frequently detected type (79.2%). When tonsil divided into 27 areas, majority of tonsilloliths were found in the center of the tonsil.


As this study was performed based on large samples compared to previous studies, the results can be applied as the guideline for diagnosis of tonsilloliths on CT images.

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