Abraham Zephania Saitabau, Kahinga Aveline Aloyce
Department of Surgery, University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania.
Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Int J Surg Case Rep. 2023 Apr;105:107999. doi: 10.1016/j.ijscr.2023.107999. Epub 2023 Mar 20.
Unilateral choanal atresia is a congenital anomaly where a newborn baby is born with a unilateral imperforate posterior nare. In most of the time the diagnosis may be missed for years after birth. A rhinolith is an entity formed by gradual deposition and coating of different salts of calcium and magnesium over an endogenous or exogenous nidus in the nasal cavity. Coexistence of a rhinolith and choanal atresia is a very rare encounter in clinical practice and to the best of our knowledge this is perhaps the first documented case in Tanzania.
We present a 15-year old boy who was attended at our department with a longstanding history of left sided non-foul smelling nasal discharge which was noticed first when he was 5 years old but at the age of 13 years, he presented with ipsilateral nose bleeding and episodic foul smelling nasal discharge. He was attended at various peripheral health facilities without relief.
The patient underwent left sided nasal endoscopy where unilateral choanal atresia and a rhinolith were found. Transnasal endoscopic choanal atresia release and rhinolith removal were done under general anaesthesia in operating room. Postoperatively, he was kept on a nasal decongestant, a broad-spectrum antibiotic, intranasal corticosteroid and an analgesic.
Clinicians must have a high index of suspicion so as to establish the diagnosis of unilateral choanal atresia in patients with persistent unilateral non-foul smelling discharge and also nasal foreign bodies in those with foul smelling nasal discharge.
单侧后鼻孔闭锁是一种先天性异常，新生儿出生时单侧后鼻孔无孔。大多数情况下，出生后数年可能会漏诊。鼻石是由钙和镁的不同盐类在鼻腔内源性或外源性病灶上逐渐沉积和包裹形成的实体。鼻石与后鼻孔闭锁并存在临床实践中非常罕见，据我们所知，这可能是坦桑尼亚首例有记录的病例。
我们报告一名15岁男孩，他因左侧鼻腔长期无异味流涕前来我院就诊，这种情况最早在他5岁时被发现，但在13岁时，他出现同侧鼻出血和间歇性异味流涕。他曾在多家基层医疗机构就诊但症状未缓解。
患者接受了左侧鼻内镜检查，发现单侧后鼻孔闭锁和鼻石。在手术室全身麻醉下进行了经鼻内镜后鼻孔闭锁松解术和鼻石切除术。术后，他接受了鼻减充血剂、广谱抗生素、鼻内皮质类固醇和镇痛药治疗。
临床医生必须保持高度怀疑，以便对持续性单侧无异味流涕的患者诊断单侧后鼻孔闭锁，对有异味流涕的患者诊断鼻腔异物。
