Tonsilloliths or tonsil stones are calcifications that form in the crypts of the palatal tonsils. These calculi are composed of calcium salts, alone or in combination with other mineral salts, and are usually small, although there have been occasional reports of large tonsilloliths or calculi in peritonsillar locations. Most often, these calculi are asymptomatic and small, often detected only by computed tomography (CT), although large calculi may be visible in routine panoramic radiographs. Although tonsilloliths normally do not require medical attention, they may become large enough to cause a variety of symptoms requiring treatment. Here, we report the case of a 45-year-old male with difficulty opening the mouth and previous treatment for carcinoma of the left buccal mucosa 6 years earlier. Routine orthopantomography revealed large, bilateral, radiopaque areas over the ramus of the mandible. A diagnosis of multiple tonsilloliths was made after confirming the exact location of the radiopacities on CT.
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