Tonsillolith: a report of three clinical cases.

Tonsillolith is a rare dystrophic calcification as a result of chronic inflammation of the tonsils. Three asymptomatic cases of tonsillolith are reported, incidentally discovered through panoramic radiographs, which showed different sizes of radiopaque images, varying from 2 to 5 mm; cases I and III images did not overlap the mandible ramus, which led to a probable diagnosis of soft tissue calcification. Case II had radiopaque unilateral images, with osseous tissue density, overlapping the mandibular ramus, leading to a benign intra-osseous lesion, which was considered as differential diagnosis. No symptoms were reported in any case. Only case I had clinical characteristics, showing highly consistent white plaques partially visible through the mucosa. Computed tomography of the maxillofacial region/head and neck were requested to find out the exact location of these images, since most of the overlapping radiopaque images in the mandibular ramus were very similar to intra-osseous abnormalities. The computed tomography showed hyperdense images in the palatine tonsils, confirming the diagnosis of tonsillolith. The patients are currently under follow-up. No treatment is required if there is no symptom. In conclusion, tonsillolith might show images on panoramic radiographs similar to intra osseous abnormalities. The diagnosis is relatively easy when computed tomography is requested, although the images are not pathognomonic. Therefore, clinicians should consider other pathologies as differential diagnosis.

Tratamento cirúrgico e conservador de cisto periapical de grande proporção: relato de caso / Surgical and conservative treatment of large periapical cyst: case report

O objetivo deste estudo foi descrever uma técnica de tratamento conservadora, cuja conduta preconizada foi a realização da descompressão seguida pela enucleação cística através do relato de um caso de cisto periapical de grande extensão. Paciente de 50 anos de idade, melanoderma, apresentando cisto periapical com aproximadamente 4,5 cm em seu maior diâmetro associado ao incisivo central inferior esquerdo. Na primeira etapa do tratamento, foi realizada descompressão cística e biopsia incisional, cujo exame histopatológico confirmou o diagnóstico clínico. Após 25 semanas de acompanhamento, houve uma considerável regressão do tamanho da lesão e a mesma foi enucleada sem comprometimento dos elementos dentários envolvidos e dos tecidos adjacentes. O relato de caso evidenciou que o tratamento cirúrgico e conservador pode ser um recurso em cistos periapicais de maior dimensão, sendo importante a cooperação do paciente no acompanhamento pós-operatório.

The aim of this study was to describe a conservative treatment technique, the recommended therapeutic of which was performed decompression and followed by cystic enucleation through the report of a large periapical cyst case. A 50-year-old melanoderma patient presented a periapical cyst with approximately 4,5 cm in its largest diameter associated with the left lower central incisor. In the first stage of the treatment, cystic decompression and incisional biopsy were performed; whose histopathological examination confirmed the clinical diagnosis. After follow-up, there was a considerable regression of the size of the lesion and it could be enucleated without compromising the dental elements involved and adjacent tissues. The case report showed that surgical and conservative treatment may be a resource in larger periapical cysts, and patient cooperation in postoperative follow-up is very important.