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Table of Contents   
CASE REPORT  
Year : 2013  |  Volume : 24  |  Issue : 6  |  Page : 762-764
Intranasal inverted tooth: A rare cause of a persistent rhinosinusitis


1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Campina Grande Federal University, Paraíba, Brazil
2 Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
3 Department of Oral and Maxillofacial Surgery, Military Police Central Hospital of the State of Rio de Janeiro Military Police, Rio de Janeiro, Brazil
4 Department of Pediatric Dentistry, Postgraduate Student, School of Dentistry, UNICSUL SP, São PauloDepartment of Pediatric Dentistry, Postgraduate Student, School of Dentistry, UNICSUL SP, São Paulo, Brazil
5 Department of Pathology, School of Medicine, Paraíba Federal University, Paraíba, Brazil

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Date of Submission06-Mar-2012
Date of Decision13-Feb-2013
Date of Acceptance09-Nov-2013
Date of Web Publication20-Feb-2014
 

   Abstract 

The aim of this study was to report a case of two supernumerary teeth in the nasal cavity in a 22-year-old woman who presented pain, rhinorrhea, and inflammation of the nasal mucosa (rhinosinusitis). The computed tomograph scan showed two radiopaque images that were diagnosed as supernumerary nasal teeth. One was unerupted in the floor and the other inverted, and erupted on the floor on the left side of the nasal cavity. They were removed under general anesthesia, one through the palatine approach, and the other directly through the nasal cavity. The patient was followed for a year and there was no sign of recurrence of rhinosinusitis.

Keywords: Nasal teeth, rhinosinusitis, supernumerary teeth

How to cite this article:
Noleto JW, Prado R, Rocha JF, DaCosta MF, Barbosa CG, Toscano MG. Intranasal inverted tooth: A rare cause of a persistent rhinosinusitis. Indian J Dent Res 2013;24:762-4

How to cite this URL:
Noleto JW, Prado R, Rocha JF, DaCosta MF, Barbosa CG, Toscano MG. Intranasal inverted tooth: A rare cause of a persistent rhinosinusitis. Indian J Dent Res [serial online] 2013 [cited 2019 Oct 21];24:762-4. Available from: http://www.ijdr.in/text.asp?2013/24/6/762/127630
Supernumerary teeth are those that are additional to the normal dentition [1] and can be found both in the primary and the permanent dentition. Supernumerary teeth may occur in any of the dental arches, with a slight preference for the anterior region of the maxilla. [2] The supernumerary teeth can be developed singly or in multiplies, unilaterally or bilaterally in any regions of the jaws of the same patient. In some cases can take place outside of the maxillofacial region, and can be called in these cases of ectopic teeth. [3]

Ectopic teeth may be present in any region of the maxillofacial skeleton and can be found on the palate and maxillary sinus. Some studies also report cases of rare locations, such as in the mandibular condyle, coronoid process, orbit, nasal cavity, and erupted through the skin. [4],[5]

The diagnostic of the teeth in the nasal cavity is important due to potential complications. The term nasal supernumerary tooth is commonly used to characterize this type of tooth. This study aimed to report a case of two supernumerary teeth in the nasal cavity, in which one of them was causing pain, rhinorrhea, and local inflammation of the nasal mucosa.


   Case Report Top


A 22-year-old female came to the Department of Oral and Maxillofacial Surgery of the Pedro Ernesto University Hospital complaining of pain, inflammation of the nasal mucosa, rhinorrhea in the nasal cavity on the left side and chronic rhinosinusitis. His general condition was considered optimal. The visual clinical exam showed a white color structure, similar to the crown of a tooth, measuring approximately 5 mm in it's the largest diameter, located on the floor of the nasal cavity on the left [Figure 1]. The computed tomograph scan showed a well-defined radiopaque image, suggestive of a supernumerary tooth erupted into the nasal cavity on the left side [Figure 2] and [Figure 3] and the image of another supernumerary tooth unerupted in the floor of the nasal cavity [Figure 4] and [Figure 5]. The teeth were removed under general anesthesia and one of them through a palatine approach [Figure 6] and the other directly through the left nostril with the aid of a lever apical elevator [Figure 7]. The tooth erupted was barrelshaped and the other was cone shape. One tooth had around 10 mm and the other 12 mm [Figure 8]. The patient was followed-up for o1 year, showing no signs of abnormality of the nasal mucosa.
Figure 1: Intranasal examination. A 5 mm tooth-like white structure is apparent in the floor of the left nasal cavity

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Figure 2: A sagittal cut that showing computed tomography imaging of a barrelshaped tooth protruding 5 mm from the floor of the left nasal cavity

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Figure 3: 3D reconstruction showing computed tomography imaging of a tooth in the floor of the left nostril

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Figure 4: A sagittal cut that showing computed tomography imaging of an unerupted tooth in the floor of the nasal cavity

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Figure 5: An axial cut that showing computed tomography imaging of the two tooth in the floor of the nasal cavity

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Figure 6: Palatine approach for removal of an unerupted tooth

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Figure 7: Intraoperative photograph showing the tooth erupted into the nasal cavity being removed through the left nostril

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Figure 8: The surgically removed teeth. The tooth erupted was barrel shaped and the other was cone shape. One tooth had around 10 mm and the other 12 mm

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   Discussion Top


The incidence of supernumerary teeth varies from 0.1% to 1% of the population [6] and the region of upper incisors is the most affected and could be named mesiodens [7] These teeth may erupt on the palate or in the nasal cavity or even be included in the region. The presence of teeth in the nasal cavity is a rare condition seen in the literature. Kirmeier et al. [8] reviewed the literature and found 25 nasal supernumerary teeth in 23 patients. They have a slight preference for males with a higher incidence in the third decade of life. The case reported in this study is within the most common, although the patient is a female.

The shape of the erupted tooth of our work is consistent with the literature, where the nasal supernumerary teeth usually have a specific morphology, which the most common form is the cone shape. [3] The unerupted tooth had a barrelshaped. The less frequent are the molar shape and barrelshaped types. [1]

The etiology of supernumerary teeth is still unknown. Thawley and Fierriere [6] advocate that the supernumerary teeth develop either from a third tooth bed that arises from the dental lamina near the permanent tooth bud or possibly, from splitting of the permanent bud itself. Primosch [9] don't accept this last theory because the majority of supernumerary teeth are present ectopic and single. Some cases of eruption in the nasal cavity have etiologic factors associated, such as genetic pre-disposition, offset by dental trauma, local infection, cysts or cleft palate. In rare cases, osteomyelitis and congenital syphilis may also be related. Some authors believe that the nasal supernumerary teeth are inverted mesiodens that erupted in the nasal cavity [1] or the presence of a mechanical barrier that diverts the eruption of a supernumerary tooth to the nasal cavity. [3] She also showed no changes in the local anatomy, dentition or occlusion.

Clinically, nasal supernumerary teeth may show signs and symptoms such as inflammation of the nasal mucosa, abscess of the nasal septum, deformity of the nasal pyramid, localized ulceration, runny nose, foul smell, facial pain, nasal hemorrhage, headache, and nasal obstruction. [7] Cases of naso-oral fistula, [5] rhinitis, nasal septum perforation, and chronic rhinosinusitis, [10] as our case, are also reported. They can also present asymptomatically, being diagnosed on clinical or routine radiographic examination. The patient cited in this study complained of frequent frames of local inflammation, pain and rhinorrhea.

Radiographically appears as a radiopaque image similar to a tooth in most cases. The differential diagnosis of nasal teeth includes radiopaque foreign bodies, rhinoliths; inflammatory lesions related to syphilis or tuberculosis, infection caused by fungi, exostoses, benign tumors such as hemangiomas, osteochondromas, calcified polyps, odontomas, and calcifying odontogenic cyst; and malignant tumors such as chondrosarcoma and osteosarcoma. [3],[7],[8] The use of computed tomography (CT) helps in the diagnosis and precise location of the nasal teeth. [7] The CT was also important for surgical planning in our case report.

The treatment should be carried out as soon as possible after diagnosis to avoid the increased morbidity. Usually nasal supernumerary teeth are removed through the nose or through intra-oral approaches. [9] Even in asymptomatic cases the literature has recommended the removal. The best time for the extraction of these teeth is after the formation of roots of permanent teeth closest to prevent damage during the procedure. Kim et al. [3] advocate the use of endoscopy to guide the extraction because it provides an excellent lighting, shortens the time of surgery, provides a better view, and makes the surgery more precise. If the extraction is not performed, the case should be followed radiographically. The teeth of this study were removed under general anesthesia. The unerupted tooth was removed through palatine approach and the other directly through the right nostril with the aid of an apical elevator.

Cases of ectopic teeth in the nasal cavity are rare and are likely to cause various types of complications. The same can also be confused with other diseases. Therefore, should be diagnosed and treated early; thus, avoiding future complications for the patient. The CT scan proved to be an important aid in the diagnosis and surgical planning.

 
   References Top

1.Goldman HM. Thoma´s Oral Pathology. St. Louis: CV Mosby Co; 1970.  Back to cited text no. 1
    
2.Nazif MM, Ruffalo RC, Zullo T. Impacted supernumerary teeth: A survey of 50 cases. J Am Dent Assoc 1983;106:201-4.  Back to cited text no. 2
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3.Kim DH, Kim JM, Chae SW, Hwang SJ, Lee SH, Lee HM. Endoscopic removal of an intranasal ectopic tooth. Int J Pediatr Otorhinolaryngol 2003;67:79-81.  Back to cited text no. 3
[PUBMED]    
4.Yeung KH, Lee KH. Intranasal tooth in a patient with a cleft lip and alveolus. Cleft Palate Craniofac J 1996;33:157-9.  Back to cited text no. 4
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5.Smith RA, Gordon NC, De Luchi SF. Intranasal Teeth. Report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol 1979;47:120-2.  Back to cited text no. 5
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6.Thawley SE, LaFerriere KA. Supernumerary nasal tooth. Laryngoscope 1977;87:1770-3.  Back to cited text no. 6
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7.Chen A, Huang JK, Cheng SJ, Sheu CY. Nasal teeth: Report of three cases. AJNR Am J Neuroradiol 2002;23:671-3.  Back to cited text no. 7
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8.Kirmeier R, Truschnegg A, Payer M, Malyk J, Daghighi S, Jakse N. The supernumerary nasal tooth. Int J Oral Maxillofac Surg 2009;38:1219-22.  Back to cited text no. 8
[PUBMED]    
9.Primosch RE. Anterior supernumerary teeth - Assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 9
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10.Sokolov M, Jecker P, Roth Y. Nasal teeth associated with rhinosinusitis. Rhinology 2004;42:167-70.  Back to cited text no. 10
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Top
Correspondence Address:
José Wilson Noleto
Department of Oral and Maxillofacial Surgery, School of Dentistry, Campina Grande Federal University, Paraíba
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.127630

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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