Crystallographic study of rhinoliths

The rhinolith-a possible differential diagnosis of a unilateral nasal obstruction

Rhinoliths are mineralised foreign bodies in the nasal cavity that are a chance finding at anterior rhinoscopy. Undiscovered, they grow appreciably in size and can cause a foul-smelling nasal discharge and breathing problems. Giant nasal stones are now a very rare occurrence, since improved diagnostic techniques, such as endoscopic/microscopic rhinoscopy, now make it possible to identify foreign bodies at an early stage of development. We report the case of a 37-year-old patient who, at the age of 5-6 years, introduced a foreign body, probably a stone, into his right nasal cavity. On presentation, he complained of difficulty in breathing through the right nostril that had persisted for the last 10 years. For the past four years a strong fetid smell from the nose had been apparent to those in his vicinity. Under general anaesthesia, the stone was removed in toto from the right nasal cavity. The possible genesis of the rhinolith is discussed, our case compared with those described in the literature, and possible differential diagnoses are considered.

Unusual evolution of a residual dental cyst: a giant rhinolith

Rhinoliths are calcareous concretions, consisting mainly of calcium and magnesium carbonates and phosphates. They can vary in size and shape, from small bodies to massive growths, and may invade adjacent structures. A 75-year-old female with a history of purulent discharge, nasal obstruction, and headache was observed in the ENT Department, University of Rome "Tor Vergata". Clinical examination revealed a giant rhinolith completely obstructing the right nasal cavity. Curiously, a dental CT scan showed a bony destruction area related to a residual dental cyst that had migrated superiorly into the maxilla. A transnasal, surgical approach was performed, and the rinolith was completely removed under local anaesthesia. The authors suggest that the giant rhinolith could have an odontogenic origin and that it could be an unusual complication of residual dental cyst.

Report of an Unusual Cause of Rhinolithiasis: An ‘Opioma'

We report an unusual case of unilateral rhinolith. The patient was a 21-year-old man who had a history of left-sided nasal obstruction and recurrent bouts of fetid, purulent rhinorrhea of several years’ duration. The rhinolith, which had formed around an impacted foreign body, was extracted in several pieces under local anesthesia. Laboratory evaluation revealed that the foreign body was a hardened mixture of codeine and opium wrapped in a small sheet of nylon—what we called an “opioma.”

Rhinolith of the nasal septum

We report an unusual case of rhinolith in the nasal septum in an 11-year-old girl. The rhinolith was detected on X-radiographs made for the planning of an orthodontic treatment. There were no symptoms like nasal obstruction, chronic infection or epistaxis in the young patient. The histopathologic examination after surgical removal showed hyaline cartilage, local fibrosis and pronounced hemosiderosis, indicating possible prior bleeding. Therefore, an endogenic etiology of the intraseptal rhinolith, e.g. a prior trauma of the nasal septum, is assumed. A review of the literature is included.

Rhinolithiasis: a review

A rhinolith is an object that has become lodged in the nose and has slowly calcified. It is seen on dental radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that call for more invasive surgical procedures. A history of unilateral nasal stuffiness, obstruction, and discharge is common but not always present. Two clinically diverse cases are presented.

Tonsillar calculi. Report of a case and review of the literature

A large tonsillar calculus in a 77-year-old demented woman with a history of chronic oral infections and multiple episodes of pneumonia is reported. Earlier literature describes these calcium-laden tonsilloliths as occurring in adolescence following chronic tonsillitis. Improvement in health care of the young and antibiosis militate against tonsilloliths as a serious problem in the young patient. Conversely, an ever-increasing aged population, with impaired self-care abilities or diminished cerebral function, many of whom populate nursing care facilities, and increased routine oropharyngeal screening of the aged may add significantly to the number of reported cases. In view of the potential for continuous oropharyngeal disease and the possibilities of swallowing disturbances, pneumonia, or food or liquid aspiration, which may result in lethal complications the authors urge the clinician to assess masses or calcified objects viewed on physical examination or radiographs, explore their etiology, evaluate them for removal, and not dismiss them as clinically insignificant.