Intranasal ectopic tooth.

A 43 year old woman presented to the otolaryngology outpatient department Tri-Service General Hospital, Taipei, Taiwan, in June 2013, with complaints of a left-sided nasal obstruction and purulent discharge for one year. She had no headache, facial pain, or facial pressure. Upon physical examination, the presence of a white mass covered with nasal mucosa was noted in gross rhinoscopy (Figure A). Computed tomography of the paranasal sinuses demonstrated a well-defined radiopaque mass resembling a tooth in the nasal cavity close to the nasal septum (Figure B and C). Endoscopic sinus surgery was performed to remove the mass, which was found to be a tooth of about 14 mm length (Figure D). During the follow up the patient was doing well three months postoperatively.

Fig

Intranasal ectopic tooth. (A) The rhinoscopic image of a whitish tooth covered with a mucosal membrane in the left nose. S, nasal septum; M, middle turbinate; I, inferior turbinate. (B) and (C) Pre-operative coronal and sagittal computed tomography imaging of the paranasal sinuses, depicting a tooth in the left nasal cavity (black arrow). (D) The removed tooth was complete with a length of 14 mm.

An intranasal ectopic tooth is a rare clinical entity and the cause is unclear. The incidence of supernumerary teeth generally affects 0.1 to 1.0 per cent of the population, and of these cases only a small percentage develop an intranasal tooth1. It can occur in a variety of locations including the maxillary sinus, mandibular condyle, coronoid process, orbital and nasal cavities. The endoscopic approach to remove an intranasal ectopic tooth involves better exposure of the operative field23. Ectopic teeth may be confused with other nasal cavity masses, and nasal foreign bodies, rhinoliths and exostoses should be included in the differential diagnosis.