The organic matrix of a tonsillolith is primarily composed of what material?

 # The organic matrix of a tonsillolith is primarily composed of what material?

a) Pure collagen fibers

b) Keratin and desquamated epithelial cells

c) Mucopolysaccharide complexes derived solely from salivary glands

d) Fibrin and platelet aggregates

The correct answer is b) Keratin and desquamated epithelial cells

The organic matrix of tonsilloliths (tonsil stones) primarily consists of keratinized debris from the stratified squamous epithelium lining the tonsillar crypts, along with desquamated (shed) epithelial cells, leukocytes, and bacterial biofilms. This keratin-rich nidus—formed by compacted, partially degraded squamous cells—provides the scaffold for inorganic calcification (e.g., hydroxyapatite). Histopathological analyses of excised tonsilloliths confirm this composition, showing dense keratin aggregates (up to 60–70% of the core) via light microscopy and immunohistochemistry, as detailed in studies from Acta Oto-Laryngologica and Otolaryngology–Head and Neck Surgery. Food particles and saliva contribute minorly, but the epithelial-keratin base dominates due to crypt trapping.

The other options are inaccurate: Pure collagen (a) is stromal, not luminal; mucopolysaccharides (c) are salivary adjuncts, not primary; and fibrin/platelets (d) indicate clotting, absent in chronic crypt stagnation.