Tonsillolith is a calcified mass in the tonsil and/or its surrounding tissue, which is considered to be caused by chronic tonsillitis. However, here we hypothesized that a tonsillolith can also be formed by chronic saliva stasis in the tonsillar tissue, without any signs of chronic inflammation. We present the case of a 32-year-old male patient with a large tonsillolith. We reviewed his medical files, pre-operative imaging and intraoperative findings. During a standard tonsillectomy, we encountered a large tonsillolith measuring 3.1 3 2.6 cm. Additionally, a careful dissection of the lower pole of the remaining tonsillar tissue revealed a large fistulous tract filled with saliva. Post-operative examination of the pre-operative CT scan found a hypodense fistulous tract extending from the lower tonsillar pole towards the left submandibular gland, measuring 36 mm in length, which was diagnosed as an accessory duct of the submandibular gland. To our knowledge, this is the first case of a large tonsillolith associated with the accessory duct of the ipsilateral major salivary gland. Furthermore, from the aetiopathological view, this finding supports the saliva stasis hypothesis for formation of the tonsillolith. However, larger studies, including a detailed radiological analysis as in our case, are needed to further investigate this possible aetiology of tonsilloliths.
Objective: To describe a rare case of a paraneoplastic neurological syndrome associated with tonsillar squamous cell carcinoma. Design: Case report. Patient: A 51-year-old female patient with paraneoplastic neurological disorder characterized by rapid and progressive bilateral facial paresis, diplopia, arm and leg weakness and paresthesia. Interventions: Symptomatic therapy for pain, surgery and radiotherapy for cancer. Main outcome measures: Medical fi le, radiological imaging, EMNG, immunological fi ndings and surgical report. Results: Patient neurological status drastically improved in early postoperative period (after primary surgical intervention). Only mild right facial paresis persisted upon release from hospital. Patient is scheduled for radiotherapy. Conclusion: This is to our knowledge fi rst case of paraneoplastic neurogical syndrome with demyelinating polyradiculoneuropathy associated with tonsillar carcinoma. In a case of an early staged carcinoma, symptomatic therapy and surgery alleviated or slowed progression of symptoms.
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