Panoramic radiography is a useful screening tool for an array of dental and nonodontogenic disorders related to calcification as well as assessment of trauma and development of the oral and maxillofacial complex. Rotational movements of the radiographic source and detector plate may promote ghost image formation, particularly with larger radiopaque objects, and complicate the radiographic interpretation. This article describes cases of a giant submandibular gland sialolith and a giant tonsillolith, each of which appeared as a bilateral presentation due to contralateral ghost images, and discusses their clinical, demographic, and radiographic characteristics. Computed tomographic examinations were used to confirm the unilateral presentation of these objects and for determination of the extent of adjacent soft tissue impingement. Distinguishing an actual panoramic image from a ghost artifact may avoid unnecessary surgical intervention and improve clinical outcomes.
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