|Year : 2021 | Volume
| Issue : 3 | Page : 321-323
Extraction of supernumerary nasal tooth by endoscopic approach
Tanzeem Ahmed1, Samsuddin Ahmed2, Nikhil Kaushal1
1 Kaushal Dental Care Centre, Delhi, India
2 Department of ENT, Military Hospital, Secunderabad, Telangana, India
|Date of Submission||02-Sep-2020|
|Date of Decision||26-Sep-2020|
|Date of Acceptance||16-Oct-2020|
|Date of Web Publication||21-Sep-2021|
Dr. Tanzeem Ahmed
P3D Hanuman Temple Complex Pocket 1, Trimulgherry, Secunderabad - 500 015, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The occurrence of the supernumerary tooth in the nasal cavity is uncommon. If not diagnosed and treated early, it may lead to various complications. Nasal endoscopy not only helps in proper diagnosis but also is an effective approach towards the extraction of the nasal tooth. It increases precision and reduces morbidity associated with the surgery.
Keywords: Ectopic supernumerary teeth, endoscopy, nasal teeth
|How to cite this article:|
Ahmed T, Ahmed S, Kaushal N. Extraction of supernumerary nasal tooth by endoscopic approach. Contemp Clin Dent 2021;12:321-3
| Introduction|| |
The presence of extra teeth in addition to the normal dental formula is known as supernumerary teeth. Those that are similar to the normal series are referred to as supplemental teeth and the ones with variation in shape and size are further classified as tuberculate or conical accessory supernumerary teeth. The ectopic eruption is one of the common complications of supernumerary teeth. The presence of ectopic supernumerary teeth in the nasal cavity is a rare occurrence. Patients with nasal tooth may have signs and symptoms such as epistaxis, paranasal sinusitis, nasal septal deviations, nasal septal abscess, rhinitis caseosa with septal perforation, aspergillosis, and oral-nasal fistula. It may also act as a nidus for mineralization in the nasal cavity surrounded by calcified material and chronic infected tissue.
This report presents a case of ectopic supernumerary tooth in the nasal cavity and its management with the aid of endoscopy.
| Case Report|| |
A 44-year-old male patient reported to the clinic with the chief complaint of nasal obstruction in the left nostril and feeling of hard mass inside the nasal cavity for 3 years. The patient's medical history was unremarkable, and there was no previous history of maxillofacial trauma or surgery. Anterior rhinoscopy revealed a white mass in the left nasal cavity. On probing, it was hard in consistency and was found to be firmly attached to the floor of the nasal cavity. On intra-oral examination, his dentition was found to be normal. Panoramic radiograph revealed a well-defined radio-opaque elongated structure in the floor of the left nostril. Radiograph of the paranasal sinuses showed a radio-opaque shadow in the left nasal cavity. Computed tomography (CT) scan revealed a smooth mass located on the floor of the left nasal cavity between the inferior turbinate and the nasal septum [Figure 1]a and [Figure 1]b. Nasal endoscopy showed a grayish white mass between the inferior turbinate and the septum surrounded by granulation tissue and necrotic debris in the left nasal cavity [Figure 1]c. A provisional diagnosis of the ectopic tooth was made, and the extraction of the tooth was planned. The patient underwent trans-nasal endoscopy of the left nostril under local anaesthesia for the removal of the nasal mass [Figure 1]d and [Figure 1]f. The gross specimen resembled a conical-shaped tooth [Figure 1]e. Histopathological examination revealed well-organized enamel and dentin with pulp cavity in the centre. At 6 weeks of follow-up, the patient was asymptomatic and no mucosal abnormalities were observed.
|Figure 1: (a and b) Coronal and axial computed tomography scan showing radio-opaque mass in left nasal cavity. (c) Nasal endoscopy showing a greyish white mass with necrotic debris in left nasal cavity, (d) Removal of the nasal mass, (e) extracted tooth, (f) Postextraction photograph showing the extraction socket in the left nasal cavity|
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| Discussion|| |
The incidence of supernumerary teeth has been found to range from 0.1%–1%. They can be found in sites outside the oral cavity like the maxillary sinus or the palate. The less frequently affected sites in the maxillofacial region that have been reported in the literature are the mandibular condyle, coronoid process, orbits, facial skin, and nasal cavity. There are various theories that have been put forward to explain the phenomenon for the ectopic eruption of teeth which includes the theory of developmental origin occurring due to reversion to the dentition of extinct primates having three pairs of incisor teeth, disturbance in the migration of neural crest derivatives destined to reach the jawbones or defect in the epithelial-mesenchymal interaction. Other causes include genetic factors, cleft lip and palate, trauma or cystic lesions leading to tooth displacement. Intranasal teeth can be asymptomatic and diagnosed incidentally during routine examination. However, some patients show signs and symptoms such as pain, nasal obstruction, purulent, or blood-tinged rhinorrhea., Diagnosis is made on the basis of clinical examination and radiographic investigation. Clinically, nasal tooth may be seen as a white mass surrounded by granulation tissue and debris; completely or incompletely embedded in the nasal mucosa. On the radiograph, it is seen as a radio-opaque lesion. The CT scan helps to further evaluate the lesion. Rhinolith, foreign body, inflammatory lesions due to syphilis, tuberculosis, or fungal infection with calcification; chondrosarcoma, osteoma, hemangioma, calcified polyps, dermoid, and enchondroma, are the differential diagnosis of nasal tooth. Histopathological examination can confirm the diagnosis. Endoscopy provides good illumination, clear visualization, and precise dissection with reduced postoperative morbidity and can be managed as a day-care procedure.,
There are very few cases in the literature reported describing the extraction of intranasal teeth by endoscopic approach and they all show encouraging results (Kim et al. 2003, Lee 2001, Kirmeier et al. 2009, Lin et al. 2004).,,
In the present case, the intranasal tooth was extracted successfully with the help of endoscope without any damage to the adjacent structures. The patient was discharged on the same day. The postoperative healing was uneventful.
| Conclusion|| |
Trans-nasal endoscopy in the management of intranasal teeth is a minimally invasive approach towards the extraction of an ectopic tooth in the nasal cavity.
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
Conflicts of interest
There are no conflicts of interest.
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