Year : 2007 | Volume
: 18 | Issue : 3 | Page : 141--143
Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A rare entity
T Srinivasa Prasad1, G Sujatha2, Thanvir Mohammad Niazi1, P Rajesh1,
1 Dept. of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
2 Dept. of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College and Hospital, Chennai, India
T Srinivasa Prasad
Dept. of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai
Ectopic eruption of teeth into a region other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin and maxillary sinus. Occasionally, a tooth may erupt in the maxillary sinus and present with local sinonasal symptoms attributed to chronic sinusitis. We present a case of an ectopic maxillary third molar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus.
|How to cite this article:|
Srinivasa Prasad T, Sujatha G, Niazi TM, Rajesh P. Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A rare entity.Indian J Dent Res 2007;18:141-143
|How to cite this URL:|
Srinivasa Prasad T, Sujatha G, Niazi TM, Rajesh P. Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A rare entity. Indian J Dent Res [serial online] 2007 [cited 2021 Oct 19 ];18:141-143
Available from: https://www.ijdr.in/text.asp?2007/18/3/141/33793
Tooth development results from a complicated multistep interaction between the oral epithelium and the underlying mesenchymal tissue. A series of complex tissue interactions result in the formation of mature teeth. Abnormal tissue interactions during tooth development may potentially result in ectopic tooth development and eruption. 
Ectopic eruption of a tooth into the dental environment is common whereas ectopic eruption of a tooth in other sites is rare.  One such site for ectopic tooth eruption in a nondental location is the maxillary sinus.  Due to its rarity, there is a dearth of literature discussing this entity.  Ectopic eruption may result due to one of the three processes: developmental disturbance, pathological process and iatrogenic activity.  Tooth eruption into the maxillary sinus may cause sinusitis,  the treatment of which (if infected) is surgical removal.  We present a case of an ectopic maxillary third molar, which presented in the right maxillary sinus with purulent rhinorrhea and was removed via a Caldwell-Luc procedure.
A 45 year-old male reported with a complaint of recurrent purulent rhinorrhea on the right side with associated pain and swelling of six month's duration. The problem did not resolve in spite of several courses of antibiotics prescribed by medical practitioners. Pus discharge into the oropharynx was evident on direct laryngoscopy examination. A coronal section computed tomography (CT) scan showed a well-defined circular opacity surrounded by a soft tissue mass in the right maxillary antrum [Figure 1]. The perforation of the medial wall and the posterior wall was also evident in a CT scan of an axial section [Figure 2]. The lateral sinus radiograph [Figure 3] confirmed the presence of an ectopic molar tooth with fully developed roots at the antero-superior aspect of the right maxillary antrum.
Clinical examination of the patient revealed the absence of the right upper third molar. He subsequently underwent removal of the ectopic tooth under general anesthesia via a Caldwell Luc procedure [Figure 4],[Figure 5]. A crevicular incision was placed up to the first molar tooth along with a vertical incisional release between the two central incisors. The bony bulge of the molar tooth was seen on the anterior wall of the maxilla. A bony window was created and the tooth was exposed. Enucleation of the contents of the tooth was done. Haemostasis was achieved and the wound closed with 3.0 vicryl suture [Figure 6]. Histopathology of the soft tissue revealed a dentigrous cyst with no evidence of malignancy. The patient has been asymptomatic over a year's follow-up.
Tooth development results from an interaction between the oral epithelium and the underlying mesenchymal tissue. This process begins in the sixth week in utero with the formation of maxillary and mandibular dental lamina in the region of the future alveolar process. This ectodermal derivative undergoes proliferation to form the permanent dentition between the 5 th and 10 th months, each mature tooth consisting of a crown and a root.  Abnormal tissue interactions during development may potentially result in ectopic tooth development and eruption. Ectopic eruption of a tooth into a region other than the oral cavity is rare although there have been reports of tooth in the nasal septum,  mandibular condyle,  coronoid process  and the palate.  Occasionally, the tooth may erupt into the maxillary antrum and present with local sino-nasal symptoms attributed to recurrent or chronic sinusitis. The diagnosis of this condition can be made radiographically with plain sinus X-rays and CT scans taken in axial and coronal sections.
Dentigerous cyst is the most common of all follicular cysts, more common in males, occurring in the second or third decade of life. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla.  If infected, the treatment of choice is complete enucleation of the lesion intraorally with removal of the associated tooth. It is also important to completely remove all diseased antral tissues and thoroughly assess all resected soft tissue histologically.  Only a few cases of "ectopic" molars which have been displaced by progressively growing dentigerous cysts have been reported in medical literature.  It is believed that the displacement of tooth buds by the expansion of these dental cysts results in the displacement of the tooth to other areas, which is attributed to the ectopic appearance of the third molar in this patient. Recurrence and malignant or ameloblastic transformation following a dentigerous cyst is rare when compared to odentogenic keratocyst. , Close observation and follow-up with periodic radiographs is required.
The treatment of an ectopic tooth in the maxillary sinus is usually removal, as if left untreated, it has the tendency to form a cyst or tumor. Caldwell-Luc procedure was followed in this case as the ectopic tooth was the cause of recurrent sinusitis and purulent rhinorrhea inspite of administering antibiotics repeatedly. The importance of ruling out related dental conditions in any patient presenting with such signs and symptoms of the head and neck region cannot be overemphasized.
|1||Goh YH. Ectopic eruption of maxillary molar tooth-an unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80-1.|
|2||Elango S, Palaniappan SP. Ectopic tooth in the roof of the maxillary sinus. Ear Nose Throat J 1991;70:365-6.|
|3||Goh YH. Ectopic eruption of maxillary molar tooth: An unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80-1.|
|4||Bodner L, Tovi F, Bar-Ziv J. Teeth in the maxillary sinus: Imaging and management. J Laryngol Otol 1997;111:820-4.|
|5||Avery JK. Oral Development and histology. 2 nd ed. Theime Medical Publisher Inc: 1994. p. 70-92.|
|6||el-Sayed Y. Sinonasal teeth. J Otolaryngol 1995;24:180-3.|
|7||Yusuf H, Quayle AA. Intracondylar tooth. Int J Oral Maxillofac Surg 1989;18:323.|
|8||Toranzo Fernandez M, Terrones Meraz MA. Infected cyst in the coronoid process. Oral Surg Oral Med Oral Pathol 1992;73:768.|
|9||Pracy JP, Williams HO, Montgomery PQ. Nasal teeth. J Laryngol Otol 1992;106:366-7.|
|10||Bhaskar SN. Synopsis of oral pathology. 7 th ed. CBS Publisher: 1986. p. 228-37.|
|11||Laskin DM. Oral surgery. 1 st ed. Cr. Mosby: 1996. p. 459.|
|12||Szerlip L. Displaced third molar with dentigerous cyst: An unusual case. J Oral Surg 1978;36:551-2.|
|13||Kramer IR. Ameloblastoma: Clinicopathological appraisal. Br J Oral Surg 1963;1:13-28.|
|14||Toller PA. Origin and growth of cyst of the jaws. Ann R Coll Surg Engl 1967;40:306-36.|