Rhinolithiasis: An uncommon entity of the nasal cavity Kaan Orhan, DDS, PhD, a Doruk Kocyigit, DDS, b Reha Kisnisci, DDS, PhD, c and Candan S. Paksoy, DDS, PhD, d Ankara, Turkey ANKARA UNIVERSITY FACULTY OF DENTISTRY Rhinoliths are uncommon foreign bodies of the nose formed by in situ calcification of intranasal endogenous or exogenous foreign material. They are often an asymptomatic condition diagnosed accidentally during a routine examination. Although nasal foreign bodies are more frequently seen in children, and appear to be more common in women, they have been reported in patients of all ages. This article describes a case of rhinolith involving a 38-year-old male. The etiology, thin-sectioned microscopic findings, differential diagnoses, and treatment are also discussed. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:E28-32) Rhinoliths are calcareous concretions that precipitate on an intranasal foreign body. 1-4 Any material in the nose can act as a potential nucleus for the deposition of salts. The crusted nidus can be either exogenous or endogenous, with the latter being more common. 2,3 Appleton et al. 1 reported that more than 600 cases had been reported in the literature since the first description of the pathology by Bartholin in 1654. 1,4,6,10 Since 1988, the total of cases which have been reported is 28, 2-23 so it is apparent that rhinoliths are quite rare pathologies in the oral maxillofacial structures. Teeth, sequestra, dried blood clots, dried pus, desquamated epithelium, leukocytes, and bone fragments are exam- ples of endogenous precipitants. Fruit, seeds, beads, but- tons, dirt, pebbles, sand, peas, parasites, wood, glass, and remains of a gauze tampon are examples of exo- genous sources. 2-4,8 Although nasal foreign bodies are more frequently seen in children, and appear to be more common in women, they have been reported in patients in patients of all ages. 1,3 They are often asymp- tomatic and diagnosed accidentally during a routine examination, but sometimes patients have complaints of symptoms. 2,8 Most patients present with symptoms that have persisted for many months or years; however, they are unable to recall deposition of a foreign body that presumably dates back to childhood. 3 The aim of this paper is to present a rare case of a rhinolith along with an analysis of the literature in order to make a contribution to the pathogenesis, treat- ment, and differential diagnosis of the rhinolithiasis. CASE REPORT A 38-year-old male patient was referred to Ankara University Faculty of Dentistry for evaluation of maxillary un- erupted teeth and caries lesions. The patient’s general med- ical history was unremarkable. The head and neck examination revealed no evidence of adenopathy, paresthesia, or motor nerve deficiency. Intraoral examination revealed missing ca- nine and premolar teeth in right the maxillary quadrant and a missing premolar tooth in the left maxillary quadrant. A peri- apical radiograph from the right maxillary canine region and an occlusal projection showed an unerupted maxillary canine tooth, lying palatal to the roots of the lateral incisor, and a cal- cified mass in the nasal cavity region discovered incidentally (Fig. 1). To examine the calcified mass in detail, a panoramic radiograph was taken. This radiograph showed a homogeneous round opacified mass on the floor of the nasal cavity (Fig. 2). It was decided to perform a computerized tomography (CT) scan for obtaining a more precise location and definition of the path- ologic features. CT imaging demonstrated significant deviation of the bony septum to the left, deviation of the cartilaginous nasal septum, and well defined rounded calcified lesion in the right inferior meatus (Fig. 3). There was no destruction or perforation of structures near the lesion. The patient showed no symptoms of nasal obstruction, purulent nasal discharge, epistaxis, or headache. He was not aware of any foreign mass in his nose. The patient could not recall a prior trauma of the nose. No dental or nasal surgery had been performed previously. The patient had a Le Fort I osteotomy under general anesthesia. A rhinolith detected in the right inferior meatus was attached to the nasal mucosa and surrounded by granula- tion tissue. The rhinolith, measuring 2.5 3 1 3 1.5 cm (Fig. 4, a), was completely removed from the posterior region of the inferior turbinate using forceps and suction. After the opera- tion clavulanate 3 times daily amoxicillin 500 mg oral (1 g) 2 3 1 and nonsteroidal antiinflammatory analgesics were pre- scribed to the patient, and oral irrigations were to be done 3 times per day during the following 2 weeks. There were no complications in the postoperative period. No recurrence or any other complication was observed in a 6-month follow-up. After the operation, the mass was submitted to the Mineralogy Section of the Geological Engineering Department of Middle East Technical University, Ankara, to identify the composition a Consultant, Department of Oral Diagnosis and Radiology. b Research Student, Department of Oral and Maxillofacial Surgery. c Professor, Department of Oral and Maxillofacial Surgery. d Professor, Department of Oral Diagnosis and Radiology. Received for publication Jul 12, 2005; returned for revision Jul 12, 2005; accepted for publication Jul 13, 2005. 1079-2104/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2005.07.036 E28