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Frontal sinus rhinoliths- case report- Hisham Elqaisi- Specialist Ophthalmologist, Jordan

Hisham Elqaisi

A 50 years old male with complain of slight headache along with forehead bulging and left eye protrusion, smoker, snoring, and mild nasal discharge was presented. By performing CT scan of the sinuses, the radiologist was sure it was osteomas. After analyzing carefully, it was found that there were no wall attachments or origin. There were four big stones inside the left frontal sinus, ethmoid inflammation, and the left maxillary sinus was also full with expanding medial wall. The patient was admitted to Shemisany Hospital where author worked and prepared for surgery. Under general anaesthesia (GA) with endotracheal tube and pharyngeal pack, supine position, head elevated, endoscopic middle meatal antrostomy – with ethmoidectomy was performed and frontal antrum was opened with pus release. About 8 cm length incisions in forehead, guided by the forehead bulge and bipolar haemostasis were done. Perforated bone, caused by the disease was found. Then the opening was enlarged by using bone saw and bone punch forceps until the first stone was removed without injuring the post lamina. All stones were removed successfully. The tube was inserted in frontal duct for eight weeks; wound was closed in two layers; which was a very good recovery. Patient was put on antibiotics for four weeks. Patient did not quit smoking. Second CT scan showed the success of surgery.