Rhinolith

Often the word rhinolith means stone in the nasal cavity. However, rhinoliths are mineralized unnoticed foreign bodies located inside the nasal cavity which often manifest by foul smelling nasal discharge or nasal obstruction. Generally, these are mineralized calcium deposits with Inspissated secretions around the unnoticed foreign bodies which make them hard in consistency. Foreign bodies can be both endogenous and exogenous types. Desiccated blood clots, ectopic teeth, and bony fragments are examples of endogenous causes whereas exogenous causes can be seeds, beads, cotton wool, pencil tips, plastic materials. In various literature various compositions of rhinoliths has been described such as calcium mineral apatite ( C a5( O H , F , C I ) ( P O4)3) , carbonated apatite (dahlite) and Iron siderite (F e2 +C O3 and ferrihydrite ( 5 F e2O3× 9 H2O )

It is commonly seen in toddlers, kids as a tendency of accidental insertion are more in their growing stage of development and curiosity for learning new things but in can be seen any age group of people irrespective of gender preponderance. As the kids do not realize or may not complain it usually goes unnoticed. It is often challenging to diagnose rhinoliths especially in kids as they get apprehensive at the time of examination which makes it difficult for the clinician to diagnose and manage promptly. Seldom neglected rhinoliths leads to foul smelling discharge or bleeding from the nose. Impacted rhinoliths often puts clinician in dilemma as any further manipulations to remove can lead to bleeding or partial removal.  If the mucosa is damaged, such particles may remain in the nasal cavity and grow through accretion of mineral salts and incrustation. Other symptoma may arise as the size of rhinolith gradually increase such as unilateral nasal discharge, unilateral purulent rhinitis with or without consecutive sinusitis, facial pain, headache, epistaxis, impairment of nasal breathing ending in complete obstruction, dacryocystitis, otorrhea foetor, anosmia, palatal perforation and septal perforation. In most of the cases, the rhinolith is located in the inferior nasal meatus

Due to mineralized compositions rhinoliths are usually seen in x-ray or CT nose. Now a days endoscope is also used for direct visualization and confirmation. Rhinoliths can take small bean shape to staghorn shape. In some situation long standing rhinoliths can lead to palatal perforations while removing as underlying mucosa is already damaged due to long standing inflammation.

Sometimes rhinoliths are impacted tightly inside the nasal cavity that it becomes hard to remove into. In such situations, often the patient is taken to the theatre for removal. Small rhinoliths are removed transnasally Endoscopic under local anaesthesia, where necessary with microscopic/endoscopic assistance. Large lesions are first fragmented within the nasal cavity, and the pieces then removed under general anaesthesia.