Atypical Presentation and Management of Giant Tonsillolith: A Case Report and Literature Review

Abstract This report details a unique case of a 53-year-old patient presenting with dysphagia, odynophagia, and trismus in ”Sf. Apostol Andrei” County Emergency Clinical Hospital Constanta, Romania. Examination revealed a large mass within the left tonsil, prompting a differential diagnosis encompassing malignancy, abscess, and foreign body. Radiological evaluation proved challenging, as the mass mimicked a tumor on initial studies. Ultimately, CT scan confirmed the presence of a giant tonsillolith measuring an exceptional 51/23/31mm - exceeding the largest previously documented case (4.2 cm). Surgical excision under local anesthesia successfully removed the tonsillolith. This case underscores the importance of considering giant tonsilloliths in the differential diagnosis of oropharyngeal dysphagia, particularly in patients with suboptimal oral hygiene. We further emphasize the potential diagnostic challenges associated with these rare presentations and the crucial role of advanced imaging modalities. A comprehensive review of the literature regarding tonsillolith formation, diagnosis, and management is included.