Rhinolith Within a Giant Concha Bullosa: A Case Report and Review of Literature.

Concha bullosa is a common anatomical variation involving pneumatization of the middle turbinate. Although usually asymptomatic, a large concha bullosa can obstruct nasal airflow and cause related symptoms. Rhinoliths, calcified formations typically found in the inferior meatus, rarely appear within concha bullosa. This report presents a rare case of a rhinolith within a giant concha bullosa in a 15-year-old male experiencing progressive, unilateral nasal obstruction. Computed tomography (CT) revealed a densely-calcified mass inside of an extensive concha bullosa, accompanied by nasal septal deviation and maxillary sinus opacity. The patient underwent successful endoscopic sinus surgery with excision of the concha bullosa's lateral and medial laminae, facilitating complete rhinolith removal and correction of septal deviation. Postoperative follow-up over 6 months showed complete symptom resolution with no recurrence. This case underscores the importance of CT imaging in evaluating unusual nasal obstructions and highlights endoscopic sinus surgery as an effective approach for extensive concha bullosa. The findings emphasize careful consideration of anatomical variations in clinical practice and contribute to the limited literature on rhinolith formation within concha bullosa. Further studies are warranted to understand the pathogenesis of rhinoliths in nasal anatomical variations.