A 38-year-old male patient who was involved in a motor vehicle accident sustained right-sided injuries to the forehead, nose, cheek, and ear. He experienced epistaxis without evidence of cerebrospinal fluid leak from the ears and nose. Two weeks later, he developed progressive nasal obstruction and mucoid nasal discharge, for which he did not seek evaluation. Over the following year, he experienced persistent symptoms, including right nasal purulent discharge, frequent epistaxis, foul smell from the nose and mouth, nasal obstruction, severe right-sided headaches, and subsequent loss of smell. An endoscopic nasal examination revealed a severely deviated septum and a yellowish-brown stony hard lesion in the posterior third of the right nasal cavity. A computed tomography (CT) scan showed deviation of the nasal septum to the right side, a radio-opaque lesion with significant calcification obstructing the right nasal cavity, and a mucus retention cyst in the ipsilateral maxillary sinus. The patient underwent rigid endoscopic examination under general anesthesia, during which a hard stony calcified mass was visualized and removed in piecemeal. Rhinolithiasis is a rare finding that is often challenging to diagnose due to non-specific symptoms. Rigid or flexible endoscopic examination of the nose aids in diagnosis, and CT scans guide surgical extraction. Proper antibiotic and analgesic therapy is on a case basis for patient management.
Keywords: chronic sinusitis; epistaxis; nasal obstruction; rhinolith(s); rhinolithiasis.
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