Rhinolithiasis. A report of 2 cases

Rhinolithiasis: clinical, radiological, and mineralogical features

BACKGROUND

Rhinolithiasis is a rare and under-diagnosed clinical entity whose etiology and pathogenesis is poorly understood.

OBJECTIVE

The objective of the study is to review the clinical and radiologic features of rhinolithiasis and mineralogical-chemical composition of the rhinoliths with the aim of shedding light on its etiology and pathogenesis.

METHODS

Our subjects consisted of 8 rhinolithiasis cases. Clinical presentations, signs, and symptoms of the patients with radiologic findings are presented, and X-ray diffraction analyses of the stones were carried out to assess their mineralogical composition.

RESULTS

Nasal obstruction appeared to be the chief symptom, followed by nasal discharge and facial pain. Neither exogenous nor endogenous nidi were identified in any of the cases. Mineralogical analyses of the rhinoliths revealed Whitlockite [(Ca,Mg)3 (PO4)2] in one and Dahllite [Ca5 (PO4,CO3)3OH] in 7 cases.

CONCLUSION

We hypothesized that some substances or organic objects form the nidi of the rhinoliths and are disintegrated over the course of mineral precipitation. This hypothesis was supported by radiologic and microscopic findings.

[General review of rhinolithiases]

OBJECTIVE

The aim of this study was to analyze the clinical presentation and characteristics of rhinolithiasis, a rare and forgotten entity.

METHODS

Between 1990 and 2007, 20 cases of rhinolithiasis presented for consultation. The clinical course noted chronic nasal discharge associated with nasal obstruction. The protocol was the same for all patients: history of disease, meticulous endonasal endoscopy and plain radiography (+/-CT scan).

RESULTS

Rhinolithiasis was found in adults (55%), females, patients living in rural areas (66%) with unfavorable socioeconomic conditions. The diagnosis delay varied between six months and eight years. The examination showed the rhinolith in the form of a grey concretion, primarily unilateral and on the right-hand side in 60% of the patients. Only one bilateral case presented following destruction of the posterior nasal septum. The rhinolith measured between 5 and 50mm in diameter with only three associated foreign bodies (15%). The rhinolith was extracted through the natural pathways under local anesthesia in 60% of the cases. Complications were rare (epistaxis 10%) and favorable progression without recurrence was generally observed after a mean 16 months of follow-up (range, six months to 11 years).

CONCLUSION

Chronic nasal discharge without a history of rhinologic disease requires an endonasal examination under good conditions after retraction. Rhinolithiasis is easily recognized, in particular on imaging studies. Treatment is simple and curative in the majority of cases.

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.