Rinolitiazis: Klinik Bulgular, Tedavi Yaklaşımı ve Eşlik Eden Patolojiler: Tek Merkez Deneyimi
Yıl 2024,
Cilt: 8 Sayı: 1, 52 - 57, 28.04.2024
Mehmet Murat Günay
,
Gökhan Toptaş
,
Esma Altan
,
Emel Çadallı Tatar
,
Cem Saka
,
Güleser Saylam
Öz
Amaç: Literatürdeki en geniş vaka serisi eşliğinde rinolitiazisin klinik bulgularını, tedavi yaklaşımlarını ve eşlik eden patolojileri tanımlamak
amaçlanmıştır.
Gereç ve Yöntemler: Kliniğimizde, 2014-2019 yılları arasında opere edilen 32 rinolitiazis olgusu retrospektif olarak incelendi. Hastaların
demografik özellikleri, rinolit lokalizasyonları, eşlik eden sinonazal patolojiler ve cerrahi verileri kaydedildi. Tüm hastalar genel anestezi
altında endoskopik yaklaşımla opere edildi ve eşlik eden sinonazal patolojiler eş zamanlı olarak tedavi edildi. Hastalar ameliyat sonrası
birinci ve altıncı aylarda endoskopik muayene ile takip edildi.
Bulgular: Hastaların 19’u kadın (%59.4), 13’ü erkek (%40.6) hastalar olup, yaş ortalamaları 35,53±15,06 idi. En sık görülen semptomlar
sırasıyla burunda kötü koku (%65.6), burun tıkanıklığı (%53.1) ve pürülan burun akıntısıydı (%15.6). 17 olguda sağ nazal pasajda, 15 olguda
sol nazal pasajda tespit edilen rinolitler, yerleşim yeri açısından en sık septum ile alt konka arasında saptandı (%65.6). Üçü ektopik dişe ait
olan sadece dört vakada (%12.5) nidus tespit edilebildi. En sık eşlik eden nazal patolojiler ise kronik rinosinüzit (%34.4), septum deviasyonu
(%25) ve alerjik rinitti (%9.4). Olguların 17’sinde (%53.1) sadece endoskopik rinolit eksizyonu yapılırken, 15 hastaya (%46.9) eşlik eden
patolojiler sebebiyle ek cerrahi müdahale gerekti. En sık yapılan eş zamanlı cerrahi girişim ise septoplasti oldu (%15.6).
Sonuç: Burun tıkanıklığı ile başvuran ve başlangıç tedavisinden sonra semptomları devam eden veya kötüleşen olgularda rinolitiazis akılda
tutulmalıdır. Rinolitiazis tedavisinin cerrahi eksizyon olması sebebiyle, uygun yaklaşım eş zamanlı cerrahi girişim gerektiren sinonazal
patolojilerin preoperatif tespit edilmesi ve rinolit eksizyonu ile aynı seansta bu patolojilerin de tedavisidir.
Kaynakça
- 1. Akkoca Ö, Tüzüner A, Demirci Ş, Ünlü C, Uzunkulaoğlu
H, Arslan N, Aktar G. Patient Characteristics and Frequent
Localizations of Rhinoliths. Turk Arch Otorhinolaryngol
2016;54(4):154-157.
- 2. Hadi U, Ghossaini S, Zaytoun G. Rhinolithiasis: a forgotten
entity. Otolaryngol Head Neck Surg 2002;126(1):48-51.
- 3. Zalagh M, Akhaddar A, Benariba F. Chronic rhinorrhea
revealing an actinomycotic rhinolithiasis with ectopic tooth. Int
J Oral Maxillofac Surg 2012;41(3):297-299.
- 4. Aksakal C. Rhinolith: Examining the clinical, radiological
and surgical features of 23 cases. Auris Nasus Larynx
2019;46(4):542-547.
- 5. Al Mastour AS, Ghnnam WM, Zubaidi AH. Rhinolith: delayed
presentation after head trauma-a case report. Case Rep
Otolaryngol 2012;2012:492081.
- 6. Demirturk Kocasarac H, Celenk P, Erzurumlu Z, Kutlar
G. Clinical and radiological aspects of rhinoliths: report of
five cases. Oral Surg Oral Med Oral Pathol Oral Radiol
2013;116(2):232-237.
- 7. Appleton SS, Kimbrough RE, Engstrom HI. Rhinolithiasis: a
review. Oral Surg Oral Med Oral Pathol 1988;65(6):693-698.
- 8. Yuca K, Caksen H, Etlik O, Bayram I, Sakin YF, Dülger
H, Kiriş M. The importance of rigid nasal endoscopy in the
diagnosis and treatment of rhinolithiasis. Auris Nasus Larynx
2006;33(1):19-22.
- 9. Ozcan I, Ozcan KM, Ensari S, Dere H. Rhinolithiasis with a
nasal polyp: a case report. Ear Nose Throat J 2008;87(3):150-
151.
- 10. Varadharajan K, Stephens J, Madani G, Parikh A. Rhinolith
causing unilateral chronic maxillary rhinosinusitis. BMJ Case
Rep 2014;2014:bcr2014204649.
- 11. Ozdemir S, Akbas Y, Görgülü O, Selçuk T, Sayar C.
Rhinolithiasis: review of 21 cases. Am J Rhinol Allergy
2010;24(6):136-139.
- 12. Özdemir S, Görgülü O, Akbaş Y, Selçuk T, Sayar H, Tarkan
Ö. An unusual co-presentation of rhinolithiasis and squamous
cell carcinoma in the nasal cavity. J Craniomaxillofac Surg
2012;40(5):e137-139.
- 13. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R,
Reitsma S, et al. European Position Paper on Rhinosinusitis
and Nasal Polyps 2020. Rhinology 2020;58(Suppl S29):1-464.
- 14. Seyhun N, Toprak E, Kaya KS, Dizdar SK, Turgut S.
Rhinolithiasis, a rare entity: Analysis of 31 cases and literature
review. North Clin Istanb 2020;8(2):172-177.
- 15. Aksakal C. A Very Rare Localization of Rhinolith: Fossa of
Rosenmuller. J Craniofac Surg 2020;31(2):e113-e114.
- 16. Aziz Y, Chauhan J, Hasan SA, Hashmi SF. Staghorn rhinolith
in nasopharynx: an unusual case. Indian J Otolaryngol Head
Neck Surg 2008;60(1):91-93.
- 17. Sumbullu MA, Tozoglu U, Yoruk O, Yilmaz AB, Ucuncu H.
Rhinolithiasis: the importance of flat panel detector-based cone
beam computed tomography in diagnosis and treatment. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(6):e65-
67.
- 18. Dib GC, Tangerina RP, Abreu CE, Santos Rde P, Gregório
LC. Rhinolithiasis as cause of oronasal fistula. Braz J
Otorhinolaryngol 2005;71(1):101-103.
- 19. Daneshbod Y, Khademi B, Janfeshan K, Rasehki AR. Intraoral
presentation of rhinolith. Otolaryngol Head Neck Surg
2008;138:535-536.
Rhinolithiasis: Clinical Findings, Treatment Approach, and Associated Pathologies: A Single-Center Experience
Yıl 2024,
Cilt: 8 Sayı: 1, 52 - 57, 28.04.2024
Mehmet Murat Günay
,
Gökhan Toptaş
,
Esma Altan
,
Emel Çadallı Tatar
,
Cem Saka
,
Güleser Saylam
Öz
Aim: To identify the characteristics of rhinolithiasis in terms of its clinical, radiological, and surgical features
in the largest case series in the literature.
Material and Methods: A rhinolithiasis series comprising 32 cases that were treated at a single
tertiary care center between 2014 and 2019 was reviewed retrospectively. The patients’ demographic
characteristics, clinical features, rhinolith localization, accompanying sinonasal pathologies, and surgical
data were noted. All patients underwent surgery via an endoscopic approach under general anesthesia,
and any concomitant sinonasal pathology was treated during the same session. The patients were
followed up with endoscopic examinations at the postoperative first and sixth months.
Results: The sample consisted of 19 female (59.4%) and 13 male (40.6%) patients, with a mean age
of 35.53±15.06 years. The most common symptoms were nasal malodor (65.6%), nasal congestion
(53.1%), and purulent nasal discharge (15.6%). Rhinoliths were located in the right nasal cavity in 17
cases and the left nasal cavity in 15 cases. The most common localization of rhinoliths was between
the septum and the inferior turbinate (65.6%). A nidus was detected in only four cases (12.5%), of
which three belonged to an ectopic tooth. The most common concomitant nasal pathology was chronic
rhinosinusitis (34.4%), followed by septal deviation (25%) and allergic rhinitis (9.4%). Endoscopic
rhinolith excision was performed in 17 patients (53.1%), while surgical intervention was required for
additional pathologies in 15 patients (46.9%). The most common simultaneous surgical intervention
was septoplasty (15.6%).
Conclusion: Rhinolithiasis should be considered in cases presenting with unilateral nasal symptoms
that persist or worsen after initial treatment. Since the treatment of rhinolithiasis is surgical excision, the
appropriate approach is the preoperative detection of pathologies which require additional surgery that
can be simultaneously undertaken with rhinolith excision.
Kaynakça
- 1. Akkoca Ö, Tüzüner A, Demirci Ş, Ünlü C, Uzunkulaoğlu
H, Arslan N, Aktar G. Patient Characteristics and Frequent
Localizations of Rhinoliths. Turk Arch Otorhinolaryngol
2016;54(4):154-157.
- 2. Hadi U, Ghossaini S, Zaytoun G. Rhinolithiasis: a forgotten
entity. Otolaryngol Head Neck Surg 2002;126(1):48-51.
- 3. Zalagh M, Akhaddar A, Benariba F. Chronic rhinorrhea
revealing an actinomycotic rhinolithiasis with ectopic tooth. Int
J Oral Maxillofac Surg 2012;41(3):297-299.
- 4. Aksakal C. Rhinolith: Examining the clinical, radiological
and surgical features of 23 cases. Auris Nasus Larynx
2019;46(4):542-547.
- 5. Al Mastour AS, Ghnnam WM, Zubaidi AH. Rhinolith: delayed
presentation after head trauma-a case report. Case Rep
Otolaryngol 2012;2012:492081.
- 6. Demirturk Kocasarac H, Celenk P, Erzurumlu Z, Kutlar
G. Clinical and radiological aspects of rhinoliths: report of
five cases. Oral Surg Oral Med Oral Pathol Oral Radiol
2013;116(2):232-237.
- 7. Appleton SS, Kimbrough RE, Engstrom HI. Rhinolithiasis: a
review. Oral Surg Oral Med Oral Pathol 1988;65(6):693-698.
- 8. Yuca K, Caksen H, Etlik O, Bayram I, Sakin YF, Dülger
H, Kiriş M. The importance of rigid nasal endoscopy in the
diagnosis and treatment of rhinolithiasis. Auris Nasus Larynx
2006;33(1):19-22.
- 9. Ozcan I, Ozcan KM, Ensari S, Dere H. Rhinolithiasis with a
nasal polyp: a case report. Ear Nose Throat J 2008;87(3):150-
151.
- 10. Varadharajan K, Stephens J, Madani G, Parikh A. Rhinolith
causing unilateral chronic maxillary rhinosinusitis. BMJ Case
Rep 2014;2014:bcr2014204649.
- 11. Ozdemir S, Akbas Y, Görgülü O, Selçuk T, Sayar C.
Rhinolithiasis: review of 21 cases. Am J Rhinol Allergy
2010;24(6):136-139.
- 12. Özdemir S, Görgülü O, Akbaş Y, Selçuk T, Sayar H, Tarkan
Ö. An unusual co-presentation of rhinolithiasis and squamous
cell carcinoma in the nasal cavity. J Craniomaxillofac Surg
2012;40(5):e137-139.
- 13. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R,
Reitsma S, et al. European Position Paper on Rhinosinusitis
and Nasal Polyps 2020. Rhinology 2020;58(Suppl S29):1-464.
- 14. Seyhun N, Toprak E, Kaya KS, Dizdar SK, Turgut S.
Rhinolithiasis, a rare entity: Analysis of 31 cases and literature
review. North Clin Istanb 2020;8(2):172-177.
- 15. Aksakal C. A Very Rare Localization of Rhinolith: Fossa of
Rosenmuller. J Craniofac Surg 2020;31(2):e113-e114.
- 16. Aziz Y, Chauhan J, Hasan SA, Hashmi SF. Staghorn rhinolith
in nasopharynx: an unusual case. Indian J Otolaryngol Head
Neck Surg 2008;60(1):91-93.
- 17. Sumbullu MA, Tozoglu U, Yoruk O, Yilmaz AB, Ucuncu H.
Rhinolithiasis: the importance of flat panel detector-based cone
beam computed tomography in diagnosis and treatment. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(6):e65-
67.
- 18. Dib GC, Tangerina RP, Abreu CE, Santos Rde P, Gregório
LC. Rhinolithiasis as cause of oronasal fistula. Braz J
Otorhinolaryngol 2005;71(1):101-103.
- 19. Daneshbod Y, Khademi B, Janfeshan K, Rasehki AR. Intraoral
presentation of rhinolith. Otolaryngol Head Neck Surg
2008;138:535-536.