Rhinolith: Delayed Presentation after Head Trauma—A Case Report

Rhinoliths are uncommon clinical entities reported in clinical practice as unusual cause of unilateral nasal obstruction and foul smell nasal discharge. Rhinolith is calcified material found in the nasal cavity incidentally or due to patient complaint. It should be suspected when patient presents with nasal symptoms and found to have stony mass showed radiologically. We reported a 28-year-old Saudi male with left sided (LT) nasal obstruction and foul smell discharge for 5 years suspected as being due to foreign body presence since childhood due to head trauma following car accident in sandy area. 1. Introduction Rhinoliths are calcified material around intranasal foreign body. They can be endogenous if occur around body tissues as tooth or exogenous if they occur around foreign subject as stones, cotton, or beads. They are found usually in anterior nasal cavity commonly associated with narrowing due to deviated septum, spurs, and/or turbinate hypertrophy. Endoscopic appearance is the main step in diagnosis which can be supported by radiology. Complete resolution of symptoms occurs after endoscopic surgical removal [1–3]. 2. Case History A 28-year-old Saudi male presented to ORL HNS clinic referred from another hospital for his complaint of left (LT) nasal obstruction and foul smell discharge for five years. Symptoms were progressively noticed and disturb the patient’s life in the last 3 years. He received multiple courses of antibiotics and nasal steroids with no benefit. He had no history of foreign body introduced into nasal cavity. He had history of head trauma after car accident at childhood in sandy area. Anterior rhinoscopy showed irregular hard material with crustations and thick secretions around, stuck between septal spur and inferior turbinate at LT anterior nasal cavity (Figure 1). Trials of removal in clinic failed causing epistaxis. Plain X-ray and CT scan showed dense irregular material at LT nasal cavity occupying floor without extension outside nasal cavity (Figure 2). Rhinolith was suspected then endoscopic removal done anteriorly after rhinolith was divided in two pieces and bleeding controlled (Figures 3 and 4). Then antibiotic ointment was applied in the place and patient given oral augmentin 625？mg three times daily along with nasal decongestant and analgesia for one week. Patient came to the clinic after one week later in better condition with dramatic improvement and resolution of symptoms. Figure 1: Rhinoscopy view of rhinolith (IT: inferior turbinate, S: septum, R: rhinolith). Figure 2: CT showing rhinolith. Figure 3: Rhinoscopy