Rhinolithiasis Associated with Ectopic Nasal Tooth: A Rare Case Report

Rhinoliths are rare entities that result from the deposition of calcium and magnesium salts over a period of time around a nidus within the nasal cavity. These formations can lead to a variety of nonspecific symptoms, including nasal obstruction, fetid discharge, and occasionally facial pain. While the nidus is often a foreign body introduced into the nasal passage during childhood, it may also originate endogenously. Ectopic eruption of teeth into the nasal cavity is another rare phenomenon, typically linked to developmental disorders, maxillofacial trauma, or anomalies such as cleft palate. The presence of an ectopic tooth within a rhinolith is an unusual finding that poses a diagnostic and surgical challenge. This case report illustrates such a rare coexistence and highlights the importance of thorough evaluation and imaging in patients presenting with chronic unilateral nasal symptoms.

A [38]-year-old [male] patient presented to our outpatient clinic with a history of persistent unilateral nasal obstruction and foul-smelling nasal discharge that had been ongoing for several months. The patient denied any history of facial trauma, previous nasal surgery, or known congenital anomalies. Clinical examination through anterior rhinoscopy revealed a hard, irregular mass in the [left/right] nasal cavity covered with crusts and mucopurulent discharge. Nasal endoscopy further demonstrated a calcified lesion obstructing the nasal passage.

To further evaluate the lesion, a non-contrast CT scan of the paranasal sinuses was obtained. The imaging revealed a dense, well-circumscribed calcified mass suggestive of a rhinolith, with a radiodense core resembling the shape and density of a tooth. The patient was scheduled for endoscopic surgical removal under general anesthesia. Intraoperatively, the rhinolith was carefully dissected and extracted. Embedded within the mass was a single tooth-like structure, consistent in appearance with a fully formed ectopic tooth. The surrounding nasal mucosa was inflamed but intact, and there was no evidence of bony erosion or oroantral communication.

The postoperative course was uneventful, and the patient reported immediate improvement in nasal airflow. Follow-up visits at one and three weeks demonstrated good healing of the nasal mucosa, with resolution of symptoms. The patient was referred for dental evaluation to assess the status of the permanent dentition and to rule out other ectopic teeth. Histopathological analysis of the specimen confirmed the diagnosis of a rhinolith containing dental tissue.

Rhinolithiasis is a rare condition that occurs when mineral salts deposit around a foreign body or endogenous material within the nasal cavity. This process may take years to develop and usually results in the formation of a hard, stone-like mass. Patients typically present with chronic unilateral nasal symptoms such as obstruction, fetid discharge, epistaxis, and sometimes facial pain or discomfort. The presence of an ectopic tooth in the nasal cavity, although extremely rare, has been documented in a limited number of cases. These teeth are generally supernumerary and may be associated with developmental anomalies such as cleft palate, trauma, or may occur spontaneously without any known cause.

The diagnosis of a rhinolith with an embedded ectopic tooth requires a high index of suspicion, particularly in patients with unexplained, chronic nasal symptoms. Imaging, particularly CT scanning, is crucial in identifying the extent and composition of the calcified mass and in distinguishing it from other nasal pathologies such as osteomas, calcified polyps, or neoplasms. In this case, CT imaging revealed a radiopaque mass consistent with a rhinolith, and the presence of a central structure resembling dental tissue was indicative of an ectopic tooth.

Surgical removal remains the definitive treatment for rhinoliths. Endoscopic approaches are preferred due to better visualization, minimal morbidity, and quicker recovery. Complete removal of the mass, including the ectopic tooth, is essential to relieve symptoms and prevent recurrence. Postoperative follow-up is necessary to monitor healing and rule out any residual pathology or complications [1-4].

This case report presents an unusual coexistence of rhinolithiasis and an ectopic nasal tooth in a single patient. It emphasizes the importance of a thorough clinical and radiological assessment in patients presenting with persistent unilateral nasal symptoms. Awareness of such rare entities can aid clinicians in timely diagnosis and management, thereby preventing potential complications and improving patient outcomes.

None.

No conflict of interest.

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4. Boloor V, Pai KM, Rao KA (2011) Ectopic tooth in the nasal cavity: A case report. Indian J Dent Res 22(2): 371-373.