Intranasal Tooth

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-
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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