1991 Volume 84 Issue 1 Pages 61-66
Recently we treated a patient with a tonsillolith 8.5 grams in weight which is believed to be the heaviest reported in Japan so far. This 26-year-old male patient visited a hospital complaining of pharyngeal pain with no difficulty in swallowing or trismus. A diagnosis of peritonsillar abscess was made from the local findings. Prior to this episode a stony mass had been expelled from right tonsil spontaneously. Tonsillectomy was indicated for the history chronic angina and recurrent peritonsillar abscess. On the morning of admission the tonsillolith was expelled spontaneously, but tonsillectomy was performed because of chronic angina. The operative findings suggested that the stone had been in the right upper region between the capsule of the tonsil and the superior constrictor muscle. It was yellowish gray and measured 30×26×16mm. Chemical analysis revealed calcium phoshate. In the world literature there have been about 20 reports of large tonsilloliths. This is the largest reported so far in Japan. Our observations and previous reports suggest that recurrent inflammation of the tonsils and peritonsillar tissues promote the accumulation of inflammatory debris in tonsillar crypts, which then become the organic nidus for stone formation. Salts from the saliva may precipitate to form tonsilloliths that gradually increase in size.
