Bilateral sinoliths in the ethmoid sinus – a rare Cone Beam CT finding

Abstract

Sinoliths are calculi found particularly in paranasal sinuses, the rarest location being the ethmoid air cells. There were previously reported only 4 cases of unilateral large ethmoidal sinoliths (ES), this one being the fifth report. We report here the incidental bilateral evidence in a 34-year-old female patient evaluated in Cone Beam Computed Tomography (CBCT) of minor ES. The left ES, of 1.6 mm2 sagittal size, occupied the suprabullar cell, in front of the ground lamella and behind the anterior ethmoidal canal. The right ES, of 7.6 mm2, was located behind the ground lamella. The radiodensity of each ES was about 1000 HU, their bone quality being thus assessed. This is the first evidence of bilateral and clinically silent ethmoidal sinoliths. Being small-sized and incidentally found, it seems reasonable to consider that ethmoidal sinoliths could have a higher incidence but they are overlooked due to the lack of clinical manifestations.

Agger Nasi Cells Versus Lacrimal Cells and Uncinate Bullae in Cone-Beam Computed Tomography

“…This study demonstrated that CBCT could be a more reliable tool for the evaluation of nasal pneumatizations, as previously assessed. 12,29,31 The need for CBCT prior to any surgical procedure should be determined on a case-by-case basis, as the common Vesalian anatomy is frequently overridden by anatomical variations. 32,33…”

The Prevalence of Soft Tissue Calcifications in the Head and Neck Region Using CBCT among Egyptian Population

“…These criteria are important factors in the radiographic interpretation of soft tissue radiopacities. 3,16 So that, dentists should identify, diagnose, treat or refer for treatment all pathological findings on radiographs. A combination of clinical, dental and radiographic examinations help to confirm most soft tissue calcifications and if needed additional radiographic method may be used to detect them.…”

“…The presence of sinolith in the ethmoidal sinus is very rare and only 5 cases in the English literature were documented with ethmoidal sinolith as mentioned by Sava and Rusu. 16 Our case is considered the 6th one. There were 3 cases with uncertain final diagnosis as their radiographic features didn't resemble the radiographic criteria to any of the soft tissue calcifications.…”

Sphenoidal and ethmoidal sinoliths

“…Sinoliths are rarely encountered calculi lodged in the paranasal sinuses 1 . They are also termed antroliths, rhinoliths, antral calculi, antral stones, or antral rhinoliths 2 .…”

“…They are also termed antroliths, rhinoliths, antral calculi, antral stones, or antral rhinoliths 2 . There were reported sinoliths of the maxillary sinus 3 , ethmoidal sinuses 1,[4][5][6] , frontal sinuses 7,8 . The most rarely reported are the sphenoidal sinoliths.…”