Indian Journal of Dental Research

CASE REPORT
Year
: 2013  |  Volume : 24  |  Issue : 6  |  Page : 756--758

Transoral removal of ectopic maxillary third molar situated superiorly to maxillary antrum and posteroinferiorly to the floor of orbit


Anshul Rai1, Neha J Rai2, Monika A Rai2, Gauravi Jain3,  
1 Oral and Maxillofacial Surgeon, Departments of Trauma and Emergency Medicine, AIIMS, Bhopal, Madhya Pradesh, India
2 Private Practitioner, Bhopal, Madhya Pradesh, India
3 Department of Prosthodontics, Rishiraj College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India

Correspondence Address:
Anshul Rai
Oral and Maxillofacial Surgeon, Departments of Trauma and Emergency Medicine, AIIMS, Bhopal, Madhya Pradesh
India

Abstract

Only few cases of ectopic third molar in relation to the roof of maxillary sinus and posteroinferior to the floor of the orbit have been reported in the literature. The diagnosis is usually done by plain-film radiography. «DQ»Caldwell-Luc«DQ» operation or endoscopic procedures have been used for the removal of such type of ectopic tooth. We report a case of 46-year-old female patient who presented with pain, swelling and watering of eye due to the ectopic tooth. The trans oral removal (via «DQ»Caldwell-Luc«DQ» operation) of the ectopic maxillary third molar situated superior to maxillary antrum and posteroinferior to the floor of orbit has been described in this case without any complication.



How to cite this article:
Rai A, Rai NJ, Rai MA, Jain G. Transoral removal of ectopic maxillary third molar situated superiorly to maxillary antrum and posteroinferiorly to the floor of orbit.Indian J Dent Res 2013;24:756-758


How to cite this URL:
Rai A, Rai NJ, Rai MA, Jain G. Transoral removal of ectopic maxillary third molar situated superiorly to maxillary antrum and posteroinferiorly to the floor of orbit. Indian J Dent Res [serial online] 2013 [cited 2020 Mar 29 ];24:756-758
Available from: http://www.ijdr.in/text.asp?2013/24/6/756/127628


Full Text

Ectopic teeth arise when multistep interactions between oral epithelium and underlying mesenchymal tissue, which involves in tooth development, were affected by pathological conditions such as the presence of cyst and tumors, developmental disturbances or some iatrogenic activity. [1] Third molars and canines are most frequently found in abnormal positions. Ectopic teeth are common in mandible and females and can occur in both deciduous and permanent dentitions. [2] The aim of this paper is to report a case of trans oral removal of ectopic tooth situated superiorly to maxillary antrum and posteroinferiorly to the floor of the orbit.

 Case Report



A 46-year-old woman visited to our out-patient department with the complaints of watering from the left eye, pain and swelling on the left side of the upper jaw region for 8 days. Antibiotics were administered by another hospital, which resulted in a decrease of symptoms and patient was referred to our department for further management.

Clinical examination revealed no lymphadenopathy or facial asymmetry. Patient disclosed extraction of left upper first molar tooth 1 year prior. Panoramic [Figure 1] and lateral skull [Figure 2] radiography showed a upper third molar crown of the tooth positioned downward and with a small follicular space enveloping the crown of the tooth. Computed tomography (CT) scans were performed, which revealed a tooth situated superiorly to maxillary antrum and posteroinferiorly to the floor of orbit [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Under general anesthesia and nasoendotracheal intubation, intraoral access was obtained through a crevicular incision from upper left canine to first molar region along with releasing incision. A three cornered flap was reflected and then extended through the maxillary sinus. The tooth was located and removed, along with the follicle, after creating a window through the post-stamp method in the anterior wall of the sinus [Figure 4]. The danger of removing the tooth intra orally is that, if any undue forces are exerted by instrument on the tooth, it will displace it into the infratemporal fossa. Hence, a careful removal is carried out in this case by the suction pressure. The tooth was pulled out by applying the tip of suction over the tooth and removed from the window after holding it with the help of "Ellis" forcep.{Figure 4}

Her post-operative course was uneventful [Figure 5]. Amoxicillin (500 mg × 3/day) for a week and diclofenac sodium (50 mg × 2/day) were prescribed for 5 days. Patient had no pain or swelling in the post-operative period.{Figure 5}

 Discussion



Only few cases of ectopic teeth affecting the orbital floor have been reported in the literature. [3],[5],[6],[7],[8],[9] However, ectopic teeth were reported at different anatomic sites such as mandibular condyle, coronoid process, sigmoid notch, nasal cavity, palate and maxillary sinus. Lamb et al. found only 35 reported cases of ectopic teeth in the sinus in English language medical literature since 1927. [4] The location of the ectopic teeth and their management reported in the literature [3],[5],[6],[7],[8],[9] are shown in [Table 1]. Third molars are the most common ectopic tooth as in our case, which is also associated with watering from eye. Ectopic permanent canines are a rarely encountered condition.{Table 1}

The aberrant eruption, trauma and ectopic tooth germ formation are the theories given to explain the ectopic placement of third molars. The most probable cause in the present case seems to be the odd position of the tooth germ because patient gives no history of trauma. She presented with a normal maxilla - mandibular growth pattern with no perceivable/obvious facial deformity. According to Tümer et al., the displacement of the tooth is due to the pressure exerted by intracystic fluid on the occlusal aspect of the tooth. [10]

Various clinical manifestations reported in the literature are due to the presence of ectopic tooth in paranasal sinuses such as recurrent or chronic sinusitis sepsis, nasolacrimal duct obstruction, osteomeatal complex obstruction, headaches, facial numbness and recurrent hemoptysis. [4] In the present case, patient complaint was watering from eye along with pain and swelling. In the present case, CT scan, orthopantogram and lateral skull radiographs were taken.

Not all ectopic teeth required removal. Teeth, which are diagnosed accidentally on radiographs, which are not associated with any pathology, do not require treatment. To prevent infection, cyst formation and weakening of the bone predisposing to fracture, the teeth should be remove. [4] The indication of removal in the present case was pain, swelling, along with watering from eye. In the literature, various techniques were mentioned for removal of such type of ectopic teeth such as endoscopic procedure, extraoral approach and intraoral removal. Surgical field magnifies by the use of endoscopes. In the present case, intraoral removal has been done due to the cost and lack of training in the use of endoscopes.

Observation and follow-up every 6 months is strongly recommended. Patient was symptomless after 6 months follow-up. Intraoral approach is superior to the extraoral and endoscopic approach due to obvious advantages over the previous approach.

 Acknowledgments



The authors wish to thank Wendy Rash and Advocate Jyotirmay Mandal for their support in grammatical corrections in the manuscript.

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