Nasopharyngeal Tonsillolith Mimicking Temporomandibular Joint Pathology: An Incidental Finding Identified on Panoramic Radiography

Abstract

Purpose: To report a rare case of a nasopharyngeal tonsillolith (NT) incidentally detected on panoramic radiography, mimicking a temporomandibular joint (TMJ) lesion, and to emphasize the diagnostic value of cone-beam computed tomography (CBCT). Case Report: A 58-year-old woman presented with intermittent TMJ pain. A panoramic radiograph revealed a well-defined radiopacity over the left TMJ region. CBCT imaging localized the lesion to the posterosuperior nasopharynx. Based on its location and radiodensity, it was diagnosed as a nasopharyngeal tonsillolith. This prevented misdiagnosis and unnecessary interventions. Conclusion: Nasopharyngeal tonsilloliths are rarely seen on panoramic images and may simulate TMJ calcifications due to projectional overlap. This case illustrates the importance of considering NTs in the differential diagnosis of TMJ-area radiopacities and highlights CBCT’s role in precise localization.

Keywords

• Nasopharynx
• Tonsillolithiasis
• Panoramic Radiograph
• Cone-Beam Computed Tomograph
• Temporomandibular joint

Nasopharyngeal Tonsillolith Mimicking Temporomandibular Joint Pathology: An Incidental Finding Identified on Panoramic Radiography

Abstract

References

1. Ozdede M, Kayadugun A, Ucok O, Altunkaynak B, Peker I. The Assessment of Maxillofacial Soft Tissue and Intracranial Calcifications via Cone-beam Computed Tomography. Curr Med Imaging Rev. 2018;14(5):798-806.
2. Acikgoz A, Akkemik O. Prevalence and Radiographic Features of Head and Neck Soft Tissue Calcifications on Digital Panoramic Radiographs: A Retrospective Study. Cureus. 2023;15(9):e46025.
3. Oda M, Kito S, Tanaka T, et al. Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health. 2013;13(1):1-8.
4. Maia PRL, Tomaz AFG, Maia EFT, Lima KC, Oliveira PT. Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults. Gerodontology. 2022;39(3):266-272.
5. Takahashi A, Sugawara C, Akita K, et al. Prevalence and imaging characteristics of nasopharyngeal and eustachian tube tonsilloliths in 2244 patients determined using computed tomography. Dentomaxillofac Radiol. 2018;47(7):20180052.
6. Ben Salem D, Guiu B, Duvillard C, Couaillier JF, Ricolfi F. Les tonsillolithes nasopharyngés au scanner: À propos de 31 cas. J Radiol. 2007;88(2):259-262.
7. Bonneville JF, Belloir A, Mawazini H, et al. Calcified remnants of the notochord in the roof of the nasopharynx. Radiology. 1980;137(2):373-377.
8. Mallya SM, Lam EW. White and Pharoah's Oral Radiology: Principles and Interpretation. 8th ed. St. Louis: Elsevier Health Sciences; 2018.

9. Song YB, Jeong HG, Kim C, et al. Comparison of detection performance of soft tissue calcifications using artificial intelligence in panoramic radiography. Sci Rep. 2022;12(1):19115.
10. Herreira-Ferreira M, Nascimento de Souza-Pinto G, Chiguti Yamashita F, et al. The influence of anatomical location on the accuracy of tonsillolith diagnosis on panoramic radiographs. Acta Sci Health Sci. 2024;46:1.
11. Vardhan BH, Gopal KS, Ganesh MR, Nagammai N, Siddique A. Soft tissue calcifications in the head and neck region: a CBCT based retrospective study. J Indian Acad Oral Med Radiol. 2022;34(4):462–465.
12. Garay I, Netto HD, Olate S. Soft tissue calcified in mandibular angle area observed by means of panoramic radiography. Int J Clin Exp Med. 2014;7(1):51–56.
13. Takahashi A, Sugawara C, Kudoh T, et al. Prevalence and imaging characteristics of palatine tonsilloliths detected by CT in 2,873 consecutive patients. Sci. World. 2014;2014:940960.
14. Yalcin ED, Ararat E. Prevalence of soft tissue calcifications in the head and neck region: a cone-beam computed tomography study. Niger J Clin Pract. 2020;23(6):759–63.
15. Özdede M, Hacıosmanoğlu N, Kaya E, et al. Sialolit: 3 olgunun klinik, radyografik ve ultrasonografik bulguları ile birlikte değerlendirilmesi. Acta Odontol. Turc. 2016;33(1):35-38.