Rhinolith in a 13-Year-Old Boy: a Case Report of a Rare Condition

Abstract

Introduction: Rhinoliths are uncommon nasal masses. They are mineralized masses found within the nasal cavity. They have various clinical presentations. Case Presentation: We report a 13-year-old boy with long-standing nasal obstruction, yellowish nasal discharge and intermittent and minimal nasal bleeding for a few weeks, who had been treated as rhinosinusitis twice. Due to the presence of long-standing symptoms, a systematic nasal examination including anterior rhinoscopy and nasal endoscopy was carried out. Nasal endoscopy revealed a whitish irregular mass along the floor of the nose at left inferior meatus. Computed tomography (CT) scan of paranasal sinuses showed a hyperdense substance in the floor of the left nostril. Rhinolith was removed endoscopically under general anesthesia, leading to the complete resolution of his symptoms. Discussion: Diagnosis of rhinolithiasis can be made by keeping a strong suspicion based upon history and symptoms. The current case report shows the importance of rigid nasal endoscopy and radiological assessment in diagnosis and management of rhinoliths, particularly if they are situated posteriorly.

Chronic sinusitis-associated antrolith

“…Antroliths are rare calcified masses generally located in the anterior nasal cavity or maxillary sinus and are of endogenous or exogenous origin. Among the exogenous causes are grains, wood, small stone fragments, seeds, and insects, while endogenous causes include blood clots, tooth fragments, and mucosal necrosis [ 2 , [5] , [6] , [7] , [8] , [9] ]. The exact pathogenesis of antroliths are not clear, although it is suspected that generally a foreign body causes surrounding inflammation, encouraging mineral deposition and serving acts as a nidus for mineral deposition [ 3 , 4 ], over a span of years [ 10 , 11 ].…”

“…Antroliths can be the cause of chronic sinusitis as obstruction can provide an environment for infection to occur. Alternatively, chronic sinusitis itself can encourage the development of an antrolith as chronic inflammation and long standing infection can foster deposition of calcium and other mineral salts in the affected area [ 2 ]. In our patient, it is unclear whether an antrolith preceded or was caused by his chronic sinusitis.…”

“…An antrolith is considerably rare, usually described in medical literature by ENT or dental specialists [ [1] , [2] , [3] , [4] , [5] , [6] ], with an estimated occurrence of 1 in 10,000 ENT patients [ 2 ]. It is a calcified mass found in the anterior nasal cavity, the maxillary sinus, and less often the frontal sinus [ 1 , 3 , 7 ].…”

“…It is a calcified mass found in the anterior nasal cavity, the maxillary sinus, and less often the frontal sinus [ 1 , 3 , 7 ]. Formation of the mass results from the deposition of calcium and magnesium salts around an organic or inorganic nucleus at the site of local inflammation caused by a foreign body [ [2] , [3] , [4] , [5] ], which can either be endogenous (intrinsic) or exogenous (extrinsic) in origin [ 2 , 5 , 8 , 9 ].…”

“…Description of this entity was first published by Bartholin in 1654 [ [2] , [3] , [4] , [10] , [11] , [12] ]. Radiologic features were described by MacIntyre in 1900 [ [2] , [3] , [4] ]. The term rhinolith was later defined by Polson in 1943 [ 12 ].…”