nasal obstruction

1. Rhinolith
Stone formation in the nasal cavity

2. Aetiology
Rhinolith forms around the nucleus of a
small exogenous foreign body
Fb introduced into the nose gives rise to
acute or chronic inflammation of nasal
mucosa with consecutive suppuration
The putrid discharge must have high
content of calcium and magnesium
Mechanical obstruction Blocks outflow of
pus and mucus
The secretion must be exposed to current
of air this concentrates pus and mucus
Permits mineral salt to precipitate Giving
rise to incrustation

3. Clinicalfeatures
More common in adults
Unilateral nasal obstruction
Foul smelling discharge which is often
blood stained
Frank epistaxis
Ulceration of surrounding mucosa
causes neuralgic pain
 pressure necrosis of septum and
lateral wall of nose

4. Examination
Color
Grey, brown, greenish black
Surface
irregular
Probe test
stony hard feel between septum and
turbinates
Brittle and easily breaks off
Surrounded by granulation

5. Diagnosis
History
Probe test : probe can be passed
Around all its corner
X ray
CT
MRI
In both CT and MRI a rhinolith will
appear as radio opaque irregular
material
Anterior rhinoscopy

6. Treatment
Removed under general anesthesia
Removed through anterior nares
Small rhinolith Can be removed by
foreign body hook
Large rhinolith Is removed by
crushing with luc forceps or by
Moores lateral rhinotomy approach

7. Differential
diagnosis
Osteoma
Odontoma
Calcified nasal polyp
Chondrosarcoma
osteosarcoma