Antrolith RAJESH BHATIA, A. P. PATHAK, R. C DEKA

A n t r o l i t h is a rare condi t ion . Rh ino l i ths are k n o w n to invade in to the maxi l lary ant rum but a Iocal ised lesion in the an t rum is very unusual . A case of an isolated an t ro l i th is presented for i ts rar i ty and for d i f fe rent ia l d iagnosis of Iocal ised antra l disease.

Case repor t J. 23 yr old male presented to the

ENT OPD of AI IMS with complaints of nasal discharge and recurrent nasal infections for the last 3 months, but wi thout any significant nasal obstruction. There was no history of bad smell and patient did not give a specific history of a foreign body in the nose. Examination revealed a central septum with mucopurulent discharge in the left nasal cavity. The turbinates were normal. No mass or foreign body was noted in the nasal cavity. The dental examination was normal and there was no swelling over the cheeks. A routine X-ray PNS revealed a Iocalised opacity in the left maxillary antrum (Fig. 1). A suspicion of dentigerous cyst or Iocalised osteoma of the maxillary antrum was radiographically made. With these findings the patient was posted for exploration of the antrum.

Operat ive f ind ings By a sublabial approach the left

maxillary antrum was explored under local anaesthesia. Bone of the anterolateral wall was very hard. On opening the antrum the mucosa was found to be thickened. On further ex- ploration, a blackish mass was found

Senior Resident ; Lecturer Assistant Professor, Department of Otolaryn- gology All-India Institute of Medical Sciences New Delhi. Acknowledgements

Authors are thankful to Prof. S. K. Kacker, Head, Department of Otolaryngology, AtlMS, New Delhi, for his encouragement in prepara- tion of this short report.

Fig. 1 ~2 X-ray PNS and lateral skull showing Iocalised radiological opacity in the left maxillary antrum.

lying within the antrum posterolaterally. On probing this a grating sensation was felt and it was felt freely mobile. This was removed and was found to be stony hard with irregular surfaces and margins. An interesting operative f inding was that there was a dehiscence of medial wall of the maxilla, with communication to the nasal cavity on that side. No portion of the antrolith, however, was found in the nasal cavity. Histopathologically the mucosa revealed changes consistent with chronic inflammation

C o m m e n t

Rhinolith is an entity which every ENT surgeon encounters once in a while. We have seen three such cases in the past 3 years at AIIMS. It is generally unilateral and found in the floor of the nose. Sometimes these rhinoliths cause erosion of the medial wall of the maxillary antrum and invade it (Ransome, 1979). But a Iocalised rhinolith in the antrum is

very unusual condition. In view of dehiscence of medial wall of maxillary antrum we can infer that to start with it was probably a small rhinolith which did not cause any rhinological symptoms at that stage but sub- sequently it eroded the medical wall by pressure necrosis and got entry into the antrum. Opacities of the maxillary antrum have been analysed by Prasad (1982) but he did not find any case of antrolith in his series. Such radiological opacities, therefore, need to be differentiated from other conditions such as osteomas or odontogenic lesions.

References

1. Prasad, R. (1982) : Clinicopathological correlation of maxillary antral opacities. Thesis submitted to the faculty of AIMSI New Delhi.

2. Ransome, J. (1979) : Foreign bodies in the nose : Rhinoliths. Scott Brown's diseases of Ear, Nose and Throat. 4th. Ed., Vol. Ill, p. 144.

50 Indian Journal of Otolaryngology, Volume 36, No. 2, June, 1984