The ectopic eruption of teeth into the intranasal
cavity is a rare clinical entity. Commonly seen in
palate and maxillary sinus, mandibular condyle,
coronoid process and even in the orbit in the
maxillofacial region . The presence of teeth has been
reported in the ovaries, testes, anterior mediastinum
and the presacral region as well. Ectopic teeth can
be supernumery, deciduous or permanent. With
the cosmetic problems of the external approach, an
endoscopic approach has become essential in the
removal of these ectopic intranasal teeth.
A 14 yrs old boy presented to the ENT OPD with
nasal obstruction on the left side with occasional
blood stained discharge for one month duration. He
had no other nasal symptoms. There was however
a history of fall with trauma to the upper (lateral)
incisors at the age of 7 yrs. The patient’s general
medical history was otherwise unremarkable. On
anterior rhinoscopy a white mass with overlying
crusts was seen on the nasal floor in the left side,
on probing it was hard in consistency and immobile.
Oral cavity examinations revealed a fractured upper
lateral incisor on the left side, the remaining dentition
were normal in appearance and number. Rest of the
ENT examination was unremarkable. Subsequent to
this a diagnostic nasal endoscopy was done which
revealed a conical white projection tapering to a
point superiorly from the floor of the left nasal cavity
with crusts surrounding. On removing the crusts
granulations we seen surrounding the tooth in the
nasal floor (Figure 1). An orthopantamogram was
taken which revealed that the patient had normal dentition. A CT-scan which was done following this
showed a radio-opaque smooth mass in the floor of
the left nasal cavity between the inferior turbinate and
nasal septum with a homogenous high attenuation
equivalent to that of a tooth (Figure 2). His routine
blood and urine examination were within normal
limits. He later underwent an endoscopic removal
of the intranasal tooth under general anesthesia.
Using a 4 mm, 0 degree rigid nasal endoscope the
ectopic intranasal tooth was removed using luc’s
forceps (Figure 3). The granulation and the remnant
nasal mucosa surrounding the tooth were also
removed and the base was cauterized. There was
minimal bleeding during the entire procedure and
the left nasal cavity was packed with medicated
ribbon gauze, which was removed after 24 hrs and
later the patient was discharged with medication.
The patient is currently on follow-up and in good
health. A radiological evaluation of the specimen
was done postoperatively which showed a root
canal confirming the diagnosis of an intranasal tooth
Figure 1: On removing the crusts granulations we
seen surrounding the tooth in the nasal floor.
Figure 2: CT-scan which was done following this showed a radio-opaque smooth mass in the floor of the left nasal cavity between the inferior turbinate and nasal septum with a homogenous high attenuation equivalent to that of a tooth
Figure 3: Using a 4mm, 0 degree rigid nasal endoscope the ectopic intranasal tooth was removed using Luc’s forceps
Figure 4: A radiological evaluation of the specimen was done postoperatively which showed a root canal confirming the diagnosis of an intranasal tooth
The incidence of supernumery teeth is between
0.1-1% of the general population. The most
common location being the upper incisors, known as
mesideons. The extra tooth has an atypical crown in
vertical, horizontal or inverted position. The etiology
of this ectopic intranasal tooth is not clear. Although
the cause of ectopic growth is not well understood
it has been attributed to obstruction at the time
of tooth eruption secondary to crowded dentition,
deciduous teeth or exceptionally dense bone .Other
causes attributed are developmental disturbances such as cleft palate, rhinogenic or odontogenic
infection and displacement as a result of trauma
or cyst . Multiple supernumery teeth are rare in
individuals with no other associated diseases or
syndrome . Males are affected approximately twice
as frequently as females [4,5]. Heredity may play a role,
as supernumeraries are common in relatives of the
The diagnosis of intranasal is made on clinical
and radiological findings. Clinically the patient
may be asymptomatic or may present with nasal
obstruction, epistaxsis, headache/facial pain, foul
smelling nasal discharge, external nasal deformities,
nasolacrimal duct obstruction [6,7]. On examination
a white mass in nasal cavity is seen surrounded by granulation tissue and debris. Complication of
intranasal tooth includes rhinitis caseosa, septal
perforation or oroantral fistula . Radiologically the
nasal tooth appears as radio-opaque lesion with the
same attenuation as that of oral teeth, as in our case.
With bone window setting, the central radiolucency
which is correlated with pulp cavity may have a spot
or a slit depending on the orientation of the teeth.
The soft tissue surrounding the radio-opaque lesion
is consistent with granulation tissue found on clinical
and pathological examination [9,10].
The differential diagnosis of intranasal tooth
include, radio-opaque foreign body, rhinolith,
inflammatory lesion with calcification (Syphilis,
Tuberculosis or Fungal Infection), calcified polyp, osteoma, enchondroma, dermoid and malignant
tumors like osteosarcoma and chondrosarcoma.
However, the CT finding of the tooth equivalent
attenuation and the centrally located cavity is
confirmatory of the diagnosis of intranasal tooth .
Removal of the intranasal tooth is generally
advised to alleviate symptom and to prevent
complication. Endoscopic removal is advantageous
in that it has good illumination, visualization and
precise removal and is more convenient and safer than the traditional open methods, with reduced
hospital stay and cosmetically satisfactory results.
Asymptomatic tooth should also be removed, if not
at least close radiographic follow-up is advised [11,12].
Intranasal tooth results from ectopic eruption
of supernumery tooth and may cause a variety of
symptoms and complications. An intranasal tooth is
a rare clinical entity and the otolaryngologist should
be aware of this while dealing with any nasal mass.
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