Tonsil stone (tonsillolitis)

The palatine tonsils are glandular structures consisting of lymphoid tissue and forming an important part of the pharyngeal lymphoid ring, the main task of which is the protective immune function. The presence of lacunae provides a large area of contact between the lymphoid tissue and infectious agents, which allows for a faster and more complete immune response. However, this same anatomical feature can lead to the accumulation and difficult removal of food debris, leukocytes, desquamated epithelium, mucus, bacteria and their decomposition products from the depths of the lacunae. Over time, the soft masses become denser and can calcify. In the vast majority of cases, the stones contain calcium carbonate, less often sulfates, nitrates of magnesium, potassium, sodium, which depends on the characteristics of nutrition, smoking and the environment in the oral cavity. Small tonsil stones may not cause any symptoms. Larger ones can cause various symptoms from bad breath to a foreign body sensation and difficulty swallowing. Bad breath is caused by volatile sulfur compounds released by microorganisms and also contained in tonsilloliths. The presence of a stone may also cause a sore throat and cough. Large stones may cause difficulty swallowing and radiating pain in the ear.
This article presents a clinical case of detection and removal of a large asymptomatic tonsillolitis. The uniqueness of the described case is the size of the removed stone - 2.5 x 1.5 cm, as well as the asymptomatic course. Tonsilloliths of this size most often cause pain and discomfort when swallowing, but the described stone was asymptomatic. In the described case, the stone was discovered as an accidental finding during a routine examination

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