Persistent Radiographic Dot in the Throat: Likely a Benign Tonsillolith
A small radiographic dot on the lower left side of the throat that has remained unchanged in size for 2.5 years is most likely a benign tonsillolith and does not require further evaluation or intervention.
Understanding Tonsilloliths
Tonsilloliths (tonsil stones) are calcified concretions that form within the crypts of the palatine tonsils due to chronic inflammation 1. They are relatively common findings on panoramic radiographs and are typically:
- Asymptomatic in most cases
- Discovered incidentally during routine radiographic examinations
- Variable in size, shape, and color
- Appear as radiopaque shadows on imaging
Clinical Significance of Your Finding
The radiographic finding in your case has several reassuring characteristics:
Stability over time: The dot has remained unchanged in size for 2.5 years, which strongly suggests benignity. According to the American College of Chest Physicians guidelines, solid nodules that have been stable for at least 2 years do not require additional diagnostic evaluation 2.
Resolution of other spots: The fact that two other spots present on the original panoramic radiograph have disappeared on the follow-up imaging further supports a benign etiology.
Typical location: Tonsilloliths commonly appear as radiopaque shadows over the ascending rami of the mandible on panoramic radiographs 3, 1.
Risk Assessment
The risk profile of your finding is very favorable:
Stability: The Fleischner Society guidelines emphasize that stability over time is a strong indicator of benignity for any type of nodule 2.
Size: Small calcifications in the tonsils are common and typically benign. Nasopharyngeal tonsilloliths are often less than 1 cm in size and frequently detected on imaging when there are no clinical symptoms 4.
Asymptomatic nature: The absence of symptoms such as dysphagia, odynophagia, or foreign body sensation further supports the benign nature of this finding 3, 5, 6.
When to Be Concerned
While your case appears benign, it's worth noting that tonsilloliths occasionally can cause:
- Halitosis (bad breath)
- Foreign body sensation
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Referred ear pain (otalgia)
- Neck pain
If you develop any of these symptoms, particularly if they persist or worsen, further evaluation would be warranted.
Conclusion
Based on the stability of the radiographic finding over a 2.5-year period and the resolution of other previously noted spots, this small dot is most consistent with a benign tonsillolith that requires no further evaluation or intervention. The American College of Chest Physicians guidelines clearly state that solid nodules stable for at least 2 years do not require additional diagnostic evaluation 2.