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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 43-45

Ectopic nasal tooth associated with cleft lip and palate


1 Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
2 Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

Date of Submission07-Nov-2019
Date of Acceptance08-Sep-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Sucharu Ghosh
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_120_19

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  Abstract 


Ectopic nasal tooth is a rare phenomenon with only 0.1%–1% incidence rate. They are more frequently found coupled with cleft lip and palate. Here, we present a case of intranasal tooth in a 12-year-old male child with operated cleft lip and palate. The condition was diagnosed only on the basis of intraoral periapical radiograph and was extracted using gauge-holding forceps at a rural health-care center. We discuss the possible etiology, clinical findings, diagnosis, and treatment modalities of this condition. The purpose of this paper is to highlight that this rare condition can be managed with minimum available equipment in a rural setup.

Keywords: Ectopic tooth, intranasal tooth, rural setup


How to cite this article:
Basu S, Sahu S, Bose A, Ghosh S. Ectopic nasal tooth associated with cleft lip and palate. Indian J Dent Sci 2021;13:43-5

How to cite this URL:
Basu S, Sahu S, Bose A, Ghosh S. Ectopic nasal tooth associated with cleft lip and palate. Indian J Dent Sci [serial online] 2021 [cited 2021 Jan 16];13:43-5. Available from: http://www.ijds.in/text.asp?2021/13/1/43/305969




  Introduction Top


Ectopic eruption is a disturbance in which the tooth does not follow its usual course. Ectopic teeth are not uncommon. They have been reported in the maxillary sinus, mandibular condyle, coronoid process, orbit, palate, chin, and skin and even in unusual sites such as ovaries, testes, anterior mediastinum, retroperitoneal area, and presacral and coccygeal regions.[1] However, the presence of teeth in the nasal cavity is rare. Its incidence ranges from 0.1% to 1% of the population.[2] They occur frequently in individuals with cleft lip and palate.[3] Its incidence among the patients with cleft lip and palate is 0.48%.[4] At least 56 cases of the nasal tooth can be found in the literature.[5] The purpose of this manuscript is to add one more case to the existing body of the literature. We find it a relevant reminder of how this rare incident can be diagnosed and treated at a rural health-care center without any advanced and costly equipment.


  Case Report Top


A 12-year-old male child was brought to the department by his parents with a complaint of an unusual white mass in the right nostril. There was no associated pain, discharge, or bleeding from the nasal cavity. History revealed that the child was born with a right-sided cleft lip and palate, which was operated at the age of 6 months.

On inspection, the white mass appeared like a crown of a canine tooth [Figure 1]. It was hard and nontender on palpation. The scar of the previous surgery was visible on the upper lip. The patient's dentition was abnormal with peg-shaped upper lateral incisors and missing upper canines and central incisors on both right and left sides [Figure 2]. A provisional diagnosis of an intranasal ectopic tooth was made on the basis of the above findings.
Figure 1: The white mass appearing like a crown of a canine tooth and scar of the operated cleft lip

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Figure 2: Peg-shaped upper lateral incisors and missing upper canines and central incisors on both right and left sides

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An intraoral periapical radiograph (IOPAR) revealed a radiopaque tooth-like structure in an inverted position [Figure 3], which confirmed our diagnosis. Due to the poor economic condition of the patient and lack of equipment in our hospital, we could not get a computed tomography (CT) scan report.
Figure 3: Intraoral periapical radiograph showing a radiopaque tooth-like structure in an inverted position

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The tooth was loosely attached to the nasal mucosa. Hence, it was easily removed with a gauge-holding forceps after dilating the nostrils [Figure 4].
Figure 4: Extracted left maxillary canine

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  Discussion Top


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, persistent deciduous teeth, or exceptionally dense bone.[6] Other proposed pathogenic factors include a genetic predisposition; developmental disturbances, such as a cleft palate and rhinogenic or odontogenic infection; and displacement as a result of trauma or cysts.[6] In our case, the etiology is most likely to be cleft palate.

It is established that there is a male predominance of 60% and no side predilection.[1] The age of discovery of the intranasal teeth ranged from 3 to 62 years.[5]

In most cases, intranasal ectopic teeth are most commonly seen as a single unilateral tooth rather than multiple teeth in both nasal cavities. Koçak et al. presented a case of bilateral intranasal ectopic tooth, which was asymptomatic on the right side and symptomatic on the left side.[5] Ectopic intranasal tooth arising from the inferior turbinate is very rare; from 1966 to the present date, only three cases have been reported.

Patients usually are asymptomatic, as our case, but may present with different symptoms, such as facial pain, nasal obstruction, headache, epistaxis, foul-smelling rhinorrhea, external nasal deformities, and nasolacrimal duct obstruction.[2] Diagnosis can be easily done by simple visualization of a hard-white mass because usually the tooth is not surrounded by the nasal mucosa. However, radiographic studies confirm the diagnosis and CT scan is considered the gold standard. In our case, due to a lack of amenities, a CT scan was not possible. Hence, we had to rely on a simple IOPAR.

The treatment consists of a simple extraction of the tooth via a minor surgical procedure. When the tooth has a bony socket in the floor of the nose, this procedure becomes extremely difficult. Intranasal, transnasal, or modified maxillary vestibular approach can be used according to the location of this intranasal tooth. Many authors prefer the endoscopic approach over conventional methods because of its optimal lighting, good identification of adjacent structures, precise dissection, reduced hospital stay, and safety.[7]


  Conclusion Top


The intranasal tooth is a rare condition that can be presented at any age with a variety of symptoms. Its treatment can vary widely from a simple extraction to complicated surgical procedures. This paper shows how this rare condition can be handled, without any advanced equipment, in a rural setup with minimum resources such as IOPAR and gauge-holding forceps.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta YK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: Case report and literature review. Int J Paediatr Dent 2001;11:221-4.  Back to cited text no. 1
    
2.
AlMulhim A, AlMomen A, AlKhatib A. Ectopic intranasal canine tooth in a child: A rare case report and literature review. Int J Surg Case Rep 2019;55:202-5.  Back to cited text no. 2
    
3.
Dalben Gda S, Vargas VP, Barbosa BA, Gomide MR, Consolaro A. Intranasal tooth and associated rhinolith in a patient with cleft lip and palate. Ear Nose Throat J 2013;92:E10-4.  Back to cited text no. 3
    
4.
Oliveira HF, Vieira MB, Buhaten WMS, Neves CA, Seronni GP, Dossi MO, et al. Tooth in Nasal Cavity of Non-traumatic Etiology: Uncommon Affection. Int. Arch. Otorhinolaryngol 2009;13:201-3.  Back to cited text no. 4
    
5.
Koçak HE, Özdamar K, Bilgi B, Acıpayam H. A rare cause of intranasal mass: Bilateral ectopic nasal teeth. Iran J Otorhinolaryngol 2017;29:287-9.  Back to cited text no. 5
    
6.
Moreano EH, Zich DK, Goree JC, Graham SM. Nasal tooth. Am J Otolaryngol 1998;19:124-6.  Back to cited text no. 6
    
7.
Yeung KH, Lee KH. Intranasal tooth in a patient with a cleft lip and alveolus. Cleft Palate Craniofac J 1996;33:157-9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
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Case Report
Discussion
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