Breda, M

Dias, L

Guimarães, J

Menezes, A

Moreira, F

Pereira, S

English

Institutional repository of Hospital de Braga

DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY | HOSPITAL DE BRAGARHINOLITHIASIS- AN UNSUAL CAUSE FOR A COMMON SYMPTOMA rhinolith is a calcified mass formed within the nasal cavity due to solidifications of mucus, debris or foreign bodies by gradualaccretion of mineral salts. They are uncommon and rarely encountered in clinical practice. A case report of a female patientpresenting with a longstanding rhinolith in her right nasal cavity is described and a review of the literature is provided.Ana Sousa Menezes,  Joana Guimarães, Filipa Moreira, Sara Pereira, Miguel Breda, Luís DiasA high index of suspicion is required for the diagnosis of such a forgotten entity. It must always be considered in patients with longstanding nasal obstruction, nasal / oral malodor, purulent rhinorrhea and chronic headache. Surgical removal is the treatment of choice.A 44-year-old female was referred by her general dental practitioner with an incidental radio-opaque lesion in the right nasal cavity onroutine computed tomography (CT) imaging before dental implant placement (Fig 1). She reported chronic unilateral nasal obstructionand intermittent blood stained rhinorrhea. She was not aware of any nasal foreign body. She denied history of nasal trauma, hyposmia,nasal pain or sensitivity, otalgia, vision problems or fevers. The patient had no surgical history. She was a nonsmoker and nondrinker anddenied illicit drug use. She was not actively taking any medications.Rhinoliths are calcareous concretions that are formed by the gradual deposition of salts on an intranasal foreign body. Nasal foreignbodies can either be exogenous (grains, seeds, insects, stone fragments, etc...) or endogenous (blood clots, tooth fragments, drysecretions, mucosal necrosis). Rinoliths may remain asymptomatic and undetected for many years. On presentation, typical symptomsare progressive unilateral nasal obstruction, rhinorrhea (usually purulent and fetid) and epistaxis. Facial pain, headache and epiphora mayalso be present. Radiological assessment is rarely needed. The treatment of choice is surgical removal under local or general anesthesia.Anterior rhinoscopy demonstrated a black mass on the floor of the rightnasal cavity with gritting sensation on probing and a substantial deviation ofthe nasal septum (NS) to the right. The foreign body was situated within thenasal septum and the inferior turbinate (IT) with complete obstruction ofthe nasal passage. The remainder of the head and neck examination wasunremarkable.Due to significant deviation of the NS, removal was impossible on theconsultation under local anesthesia. The patient underwent surgical removalof the rhinolith by endonasal approach along with septoplasty to correct thedeviated NS under general anesthesia (Fig 2). Intraoperatively erosion of theright IT which was in close contact with the rhinolith was found. Revaluationwas scheduled on postoperative day 7. Healing was uneventful. (Fig 3-4)INTRODUCTIONCASE REPORTPHISICAL EXAMINATION RADIOLOGICAL FINDINGSDISCUSSIONCONCLUSIONMANAGEMENT AND FOLLOW-UPMACROSCOPY of the mass revealed a blackish, rough foreign body.MICROSCOPIC ANALYSIS revealed an amorphic inorganic precipitate.Fig. 1- CT scan confirmed a densely calcified mass within the right nasal cavitywith mucosal thickening, closely related to the IT.REFERENCES1- Ozdemir S, Akbas Y, Görgülü O, Selçuk T, Sayar C. Rhinolithiasis: review of 21 cases. Am J Rhinol Allergy. 2010 Nov-Dec;24(6):136-9.2- Kermanshahi MS, Jassar P. A bolt from the blew: rhinolith in the nose for more than 80 years. BMJ Case Rep. 2012 Nov 27;2012. pii: bcr-2012-007322.3- Kose OD1, Kose TE2, Erdem MA1, Cankaya AB. Large rhinolith causing nasal obstruction. BMJ Case Rep. 2015 Mar 10;2015. pii: bcr2014208260.Fig. 2- Removed Rinolith. The largestfragment removed measured 3,0x1,6cmFig 3-4. Nasal endoscopy on postoperative day 7. Erosion of the right IT can be seen.

Rhinolithiasis-an unsual cause for a common symptom

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Rhinolithiasis-an unsual cause for a common symptom

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