Intranasal Tooth

J Med Sci 2005;25(5):255-258
http://jms.ndmctsgh.edu.tw/2505255.pdf
Copyright © 2005 JMS
Received: December 24, 2004; Revised: January 17, 2005;
Accepted: February 3, 2005.
* Corresponding author: Jin-Chin Lee, Department of Otolaryngology-Head
and Neck Surgery, Tri-Service General
Hospital, 325, Cheng-Gong Road Section 2, Taipei 114,
Taiwan, Republic of China. Tel: +886-2-8792-7192; Fax:
+886-2-8792-7193.
Intranasal Tooth
Hsin-Chien Chen, and Jin-Chin Lee *
Department of Otolaryngology-Head and Neck Surgery,
Tri-Service General Hospital, National Defense Medical Center,
Taipei, Taiwan, Republic of China
Hsin-Chien Chen, et al.
Ectopic or supernumerary teeth are common, but a tooth presenting in the nasal cavity is rare. Teeth in the nasal cavity may
be asymptomatic or associated with different symptoms. We report a 22-year-old man with a 2-week history of suffering from
posterior nasal dripping and the sensation of a foreign body in the nasal cavity. A supernumerary tooth was extracted from
the nose by endoscopy under general anesthesia. The identification of intranasal teeth by clinical and radiographic
examinations is not difficult. The management of such teeth is important since they have the potential to cause considerable
morbidity. The purpose of this article is to report one case of an intranasal tooth and to review the literature.
Key words: ectopic tooth, intranasal tooth, nasal cavity, supernumerary tooth
INTRODUCTION
Ectopic eruption of teeth can occur in a variety of locations
in the head region and in other regions of the body.
Teeth have been reported to erupt into the maxillary sinus,
mandibular condyle, coronoid process, orbit, palate, chin
and skin, and have also been found in the ovaries, testes,
anterior mediastinum, retroperitoneal area, and the presacral
and coccygeal regions 1,2 . However, teeth erupting into
the nasal cavity are rare. A review of the literature reveals
that approximately 78 cases of intranasal teeth have been
reported 1-11 . Intranasal teeth may present with a variety of
symptoms, or they may be asymptomatic. Clinical examination
and radiographic imaging are extremely helpful in
making the diagnosis. Treatment by surgical removal of
the symptomatic intranasal tooth alleviates symptoms and
prevents complications. Here, we present a case of an
intranasal tooth and discuss the symptoms, diagnosis and
management.
CASE REPORT
A 22-year-old man complained of posterior nasal dripping
and the sensation of a foreign body in the right nasal
cavity that had been present for 2 weeks. Physical exami-
Fig. 1 (A) The Caldwell’s view of a skull X-ray showing a
radio-opaque shadow in the right nasal cavity (arrow).
(B) A lateral view of the skull X-ray showing a toothlike
structure on the floor of the nose (arrows).
nation revealed an exophytic mass on the right floor of the
nasal cavity, abutting the nasal septum. Sinoscopy showed
a black-whitish object surrounded by ulcerative granulation
tissue within 3 cm of the right nostril. On palpation, the
object was hard and movable. The patient’s dentition was
normal with no cleft lip or palate, and he had no history of
previous facial trauma or surgery. Radiographic
examination, which included an X-ray of the paranasal
sinus and skull, showed a radio-opaque shadow on the
floor of the right nasal cavity (Fig. 1). The lesion resembled
a tooth-like structure. Because of the history of pain, the
tumor was removed from the patient under general
anesthesia. A supernumerary tooth with caries on the right
nasal floor was extracted endoscopically with dissectors
and nasal forceps (Fig. 2). The granulated mucosal tissue
was removed and the anterior nasal cavity was packed. The
postoperative course was uneventful.
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Intranasal tooth
Fig. 2 A gross view of the extracted tooth revealing some
attached mucosa and dental caries.
DISCUSSION
Intranasal teeth are rare. In 1979, Smith et al. reported
2 cases and found 27 well-documented cases in the literature
since the original description of intranasal teeth in
1897 1 . In 2001, Gupta et al. reported one case of an
intranasal tooth in a 4-year-old boy with a repair for cleft
lip and alveolus, and identified another 20 cases 2 . Since
then, an additional 28 cases have been reported 3-11 , with
approximately 78 cases of intranasal teeth reported. Most
of the articles are case reports and only two larger series of
consecutive cases have been reported 3,12 .
This literature survey revealed that the age of detection
of intranasal teeth ranged from 3 to 71 years; approximately
half of these cases were discovered before adulthood
3 . Slightly more males than females were affected
and in most cases, only one tooth was found in the nasal
cavity. However, multiple ectopic teeth have also been
reported 1,4,12 . Almost all of these cases were unilateral with
no dominance of either side of the nasal cavity; three cases
were bilateral 5,12,13 . The types of ectopic intranasal teeth
were supernumerary, deciduous, and permanent.
Intranasal teeth present a variety of symptoms that
include the sensation of a foreign body in the nose, unilateral
nasal obstruction, purulent nasal discharge, bloodstained
rhinorrhea, repeated epistaxis, nasal or facial pain,
headache, and epiphora 1,3,4 . Intranasal teeth may also be
asymptomatic and noticed incidentally on a routine clinical
or radiographic examination. Clinically, intranasal teeth
occur most commonly on the floor of the nose, approxi-
256
mately halfway between the nostril and choana 3 . Eruption
of ectopic intranasal teeth may present as hard white
masses without a covering of nasal mucosa, for which
diagnosis is usually straightforward. However, the tooth
may be embedded in the nasal mucosa surrounded with
debris, granulation, and ulcerative materials, for which a
differential diagnosis should be formulated.
The differential diagnoses that could indicate an intranasal
tooth include foreign body; rhinolith; inflammatory
lesions due to syphilis, tuberculosis, or fungal infection
with calcification; benign tumors, including hemangioma,
osteoma, calcified polyps, enchondroma, and dermoid
cysts; and malignant tumors, such as chondrosarcoma and
osteosarcoma 6 .
Radiographic examinations, including Caldwell’s view,
Waters’ view, and a lateral view of skull, occlusal radiography,
panoramic radiography and computed tomography
scans, are helpful in confirming the diagnosis of intranasal
teeth. Panoramic radiography also reveals a detailed
condition of the dentition. Computed tomography can
indicate tooth-equivalent attenuation, identify the lesion
centrally, and evaluate the depth of the eruption site, which
are all highly discriminating features that not only delineate
but also confirm the diagnosis 6,7 . Additionally, careful
inspection of dentition and consultation with a dentist is
necessary to find out about possible missing teeth and to
differentiate the diagnosis of supernumerary, deciduous,
or permanent teeth 3 .
The etiology of intranasal teeth remains unclear. However,
some of the causes proposed include displacement
due to trauma; odontogenic or rhinogenic infection; genetic
factors; developmental disturbances, such as cleft lip,
alveolus or palate; and obstruction at the time of tooth
eruption secondary to crowding of the dentition, retained
primary teeth, or dense bone 1,2 . Another possibility is that
the tooth may be pushed further up into the nasal cavity
during surgical repair of an alveolus cleft 2 .
Treatment of intranasal teeth is early surgical removal
because of potential morbidity. These morbidities include
rhinosinusitis, osteomyelitis, dacryocystitis due to nasolacrimal
duct obstruction, nasal septal abscess or perforation,
oronasal or intraoral fistula, aspergillosis, and nasal
deformity 3-6 . A very rare association of ectopic tooth with
squamous cell carcinoma of the palate in a 12-year-old
Nigerian boy has been reported 14 . Surgical removal of an
intranasal tooth in asymptomatic patients is recommended
to prevent complications, or it should be observed with
close clinical follow-up 1 . The surgical removal includes
transnasal and transpalatal approaches and may combine
ancillary procedures 3 . Usually, an intranasal tooth can be

emoved under direct vision with a head-light or mirror. In
recent years, endoscopic extraction of intranasal teeth has
been reported with great advantage and less morbidity 3-5,7-9 .
This report presents a case of a symptomatic ectopic
supernumerary tooth arising in the nasal cavity. Endoscopic
removal of the intranasal tooth was performed due
to local infection of intranasal dental caries. Once an
intranasal tooth is symptomatic, surgical removal is indicated.
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