Ectopic tooth eruption from inferior turbinate with rhinolith, rare case of ectopic tooth in nose: a case report

INTRODUCTION

Ectopic teeth in the nasal cavity are extremely rare, and their presence can lead to chronic rhinosinusitis, nasal obstruction, headaches, foul-smelling nasal discharge, and other complications. This report discusses the clinical presentation, diagnostic approach, and successful management of a patient with an ectopic tooth in the inferior turbinate, contributing to the understanding of this rare phenomenon.¹

An ectopic tooth is a condition where a permanent tooth grows in an abnormal location, often leading to issues like misalignment and premature loss of primary teeth.² Typically, teeth erupt normally when the tooth germ is positioned correctly, the eruption pathway is clear, and the dental follicle/periodontal ligament (PDL) is intact. However, if any of these factors are compromised, it can lead to disturbances in tooth eruption. Ectopic teeth occur in approximately 1.5% to 4.3% of the population.^2-5

CASE REPORT

A 38-year-old female presented with chronic unilateral nasal obstruction, foul-smelling nasal discharge from the right side, and headaches persisting for ten years.

There was no history of trauma, surgery, cleft palate, or any congenital anomalies, and the patient was otherwise healthy. Intraoral examination revealed no missing teeth. Intra-nasal endoscopy with a zero-degree endoscope showed a whitish mass on the right side of the nasal cavity, surrounded by granulation tissue and mucopurulent secretions.

The mass was difficult to palpate between the nasal septum and inferior turbinate on the right side. The mass appeared to have erupted from the right inferior turbinate.

Diagnostic imaging via computed tomography revealed an ectopic tooth in the inferior turbinate, associated with rhinolith formation. The tooth, along with the rhinolith and granulation tissue, was removed using a zero-degree nasal endoscope and nasal forceps. CT findings in our case revealed a smooth, hypodense soft tissue lesion located in the floor of the right nasal cavity, between the inferior turbinate and nasal septum. An internal homogeneous high attenuation area, equivalent to that of a tooth, was noted. The lesion was surrounded by soft tissue. High attenuation area measured 15.3×8.9×22.8 mm (TR×CC×AP). Additionally, there was a deviated nasal septum, bilateral ethmoid and maxillary sinusitis, and a right maxillary polyp.

Suction clearance was performed to remove the foul-smelling nasal secretions, and the specimen was sent for histopathological examination. The surgery was successful, leading to the resolution of symptoms.

DISCUSSION

The etiology of an intranasal tooth is broadly classified into two groups based on abnormalities in tooth germ development and migration. Predisposing factors for ectopic nasal teeth include trauma, supernumerary teeth, odontogenic or rhizogenic infections, and congenital conditions such as cleft lip or cleft palate.¹ Ectopic teeth can emerge as additional teeth on the palate or grow into the nasal cavity. Ectopic teeth located outside the oral cavity may be deciduous, permanent, or supernumerary.⁶

Several theories explain the development of ectopic teeth. One is the developmental origin theory, which suggests that primates originally had three pairs of incisors. This theory proposes that the formation of ectopic teeth results from a reversion to ancestral dentition patterns seen in extinct primates. Another explanation is the dental lamina hyperactivity theory, which states that supernumerary teeth arise from an additional tooth bud in the dental lamina.⁷ According to this theory, an intranasal tooth may develop from a dental lamina near the permanent tooth bud or due to the splitting of a permanent tooth bud.⁷

The incidence of ectopic or supernumerary teeth is rare, accounting for approximately 0.1-1% of cases. The most commonly affected sites are the maxillary sinus and the palate, whereas involvement of the nasal cavity, coronoid process, mandibular condyle, and orbits is rare.⁸ Supernumerary tooth growth may also be linked to eruption blockage caused by factors such as dental crowding, retained deciduous teeth, or thick bone.⁸

Clinical and radiological examinations are crucial for diagnosing intranasal teeth. Clinically, they may appear as white masses surrounded by granulation tissue or as an external bump along the floor of the nasal cavity on the affected side.⁹

Ectopic teeth can exhibit atypical crown orientations, either horizontally or vertically. The condition may be asymptomatic or present with various symptoms, including hyposmia, nasal obstruction, facial pain, epistaxis, and headaches.¹⁰ If left untreated, intranasal teeth can lead to complications such as naso-oral fistula, rhinitis caseosa with perforation, external nasal deformities, and fungal infections (e.g., aspergillosis).

The differential diagnosis for intranasal teeth includes foreign bodies, rhinoliths, infections such as tuberculosis or aspergillosis with calcification, nasal polyps with calcification, and benign tumors such as osteomas.¹¹ Although rare, intranasal ectopic teeth can cause significant complications if left untreated, potentially leading to oronasal fistula and septal perforation.⁸

CT scanning is used for diagnosis and treatment planning. Surgical or endoscopic removal of an ectopic tooth is the recommended treatment.¹²

CONCLUSION

A CT scan is useful for assessing the depth of eruption and planning treatment for an intranasal tooth. Surgical or endoscopic removal is recommended to prevent symptoms and complications. A combined clinical and radiological approach ensures accurate diagnosis and appropriate management.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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