Huge Rhinolith in Adult

Introduction Rhinolithiasis is a clinical symptom caused by rhinoliths (1). Today, the incidence of rhinolith in adults is low. Rhinoliths result from mineralization of an endogenous or exogenous nidus and usually develop within the nasal cavity (1). They are a mixture of 10% organic substances and 90% inorganic material incorporated into the lesion from nasal secretions (2). Exogenous rhinoliths are more common and are usually formed due to concretions around impacted foreign bodies (3), whereas endogenous rhinoliths develop spontaneously with deposition of mineral around accumulated secretions (3). The presence of rhinoliths can cause unilateral nasal symptoms, like nasal discomfort or obstruction with or without foul-smelling discharge. The severity of the symptoms depends upon the size of the rhinolith. Longterm complications for rhinoliths include nasal polyps, atrophic rhinitis, septal perforation (4) and oroantral fistula (5). Diagnosis is established via medical history, anterior rhinoscopy, and nasal endoscopy and is confirmed with radiological imaging (2). Clinical Presentation and Intervention Case 1 A 41-year-old Malay man presented with a history of intermittent right foul-smelling nasal discharge and nasal blockage for 6 weeks. It was not associated with pain and facial swelling. He denied a history of frequent running nose and blocked nose prior to the onset of the current illness. He also denied any history of putting a foreign body inside the nostril during childhood. Nasal examination using a 0-degree scope revealed an irregular hard mass and friable mucosa situated at the inferior meatus. No mucopurulent was discharge seen. The postnasal space was normal. The oral cavity and neck examination was normal. Computed tomography of the paranasal sinuses showed widening of the right nasal space with a soft tissue mass seen in the right nasal cavity (Figure 1). The adjacent inferior turbinate was thickened. He underwent an examination under general anesthesia. Intraoperatively, there were multiple stony hard masses in the right nasal cavity (Figure 2). Upon removal of the rhinolith, the area became widened. The post-operative recovery was uneventful. The histopathological examination showed calculus tissue. Biopsy from the right inferior turbinate and right inferior meatus showed moderate chronic inflammation. There is no evidence to suggest malignancy. 148