The supernumerary nasal tooth

doi:10.1016/j.ijom.2009.06.013

International Journal of Oral and Maxillofacial Surgery

Volume 38, Issue 11, November 2009, Pages 1219-1222

https://doi.org/10.1016/j.ijom.2009.06.013 Get rights and content

Abstract

Teeth exceeding the normal dental complement that have erupted into the nasal cavity are a rare pathological entity. This case report describes a female patient with recurrent complaints and fetid discharge from the left nasal cavity. The suspected clinical diagnosis of a supernumerary nasal tooth was confirmed by computed tomography. After endoscopic removal, the tooth was examined using X-ray microtomography and thin-section preparations; these findings are presented for the first time. A literature search identified 25 supernumerary nasal teeth in 23 patients.

Section snippets

Clinical case

A 49-year-old female Caucasian patient presented with recurrent complaints involving the left nasal cavity and suffering from a foul smelling discharge that had been unresponsive to medical treatment for the last 5 years. Her history excluded trauma or surgery and her family history contributed no useful information. The front teeth of the maxilla were clinically and radiographically normal. A panorama X-ray provided no clear details in the area of the nasal cavities.

Endoscopic inspection of

Review of the literature

A survey of the literature covering the period from 1 January 1959 to 1 January 2008 was conducted by two independent examiners focusing on SNTs. Owing to the relatively low specificity of the first-stage search strategy (Table 1) 1673 articles published in English were identified in PubMed (National Library of Medicine) and EMBASE (Ovid). The final selection comprised 25 well-documented cases of SNTs in 23 humans (Table 2). 20 cases reported one tooth, and in 2 cases there were two teeth. The

Discussion

SNT is a rare condition and the literature is restricted to case reports and case series only. Most SNTs are diagnosed in the third decade of life. The prevalence in the general population is unknown and the exact eruption time cannot be specified as SNTs may remain undiagnosed if they are asymptomatic in an arrested or subclinical state.

Regarding the origin of SNT, the frequently cited classical atavism theory³, which assumes the existence of a third dental lamina in the area of the front teeth

Disclaimer

The authors assert that they have no financial interest in any company or any of the products mentioned in this article.

Competing interests

The authors assert that they have no financial interest in any company or any of the products mentioned in this article.

Funding

The study was completely financed by department funding.

Ethical approval

Not required.

Acknowledgement

We thank Ms Eugenia Lamont for her valuable editorial assistance.

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Cited by (29)

Endoscopic removal of sinonasal teeth: A case series
2021, Operative Techniques in Otolaryngology - Head and Neck Surgery
There is a dearth of literature reporting endoscopic techniques for removing teeth in the nasal cavity and paranasal sinuses. The purpose of this study is to report a large case series of endoscopic removal of sinonasal teeth.
This was a retrospective case series study completed at one institution. Two rhinology and skull base surgeons performed all of the surgeries. Patients were included if they received endoscopic removal of an ectopic sinonasal tooth.
Eight patients underwent endoscopic removal of ectopic sinonasal teeth. Symptoms of patients on presentation included facial pain, nasal obstruction, nasal congestion, foul-smelling discharge and postnasal drip. Surgical techniques included direct endoscopic removal, maxillary antrostomy/uncinectomy and medial maxillectomy. All patients had complete resolution of symptoms following surgery.
This case series highlights patients who underwent endoscopic ectopic sinonasal teeth excision. This series highlights endoscopic surgical techniques as safe and effective in the management of this pathology.
Should we floss our nose? A case report of a tooth in the nasal cavity
2021, International Journal of Surgery Case Reports
Supernumerary teeth are an anomaly characterized by the existence of an additional tooth that may grow in the dental arch region, it a rare occurrence and may be confused with other differential diagnosis, it is important treat such case as they can cause considerable morbidity to the patient.
We report a case of a 16 years old female, not known case of any medical condition, who presented to the Ear, Nose and Throat clinic complaining of nasal obstruction and rhinorrhea. Physical examination and CT findings revealed a right upper central incisor tooth located in anterior aspect of right inferior meatus. The patient underwent endoscopic teeth extraction under general anesthesia.
Supernumerary tooth is a rare condition, often causes significant distress to patients and often misdiagnosed in a clinical setting. A thorough history physical examination including the anterior rhinoscopy and nasal endoscopy needs to be done for all patients. Further radiological investigations such as CT scan of the paranasal can aid and help confirm the diagnosis. The most common treatment is usually trans nasal endoscopic removal of the tooth.
Modified maxillary vestibular approach with subperiostal intranasal dissection for surgical extractions of mesiodentes impacted in the floor of the nasal cavity
2019, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
This approach is not indicated in the case of teeth erupted through the mucosa into the nose. In these cases endoscopically assisted transnasal extraction is preferred (Al Dhafeeri et al., 2014;Krishnan et al., 2013;Kirmeier et al., 2009;Lee, 2006; Sanei-Moghaddam et al., 2009;Clementini et al., 2012;Tang and Reisacher, 2014). Some authors use this endoscopic method for extraction of mesiodentes impacted right under the nasal mucosa as well (Krishnan et al., 2013;Clementini et al., 2012).
Impacted mesiodentes in the inverted position may interfere with the base of the nasal cavity or the nasal septum. They can rarely erupt into the nose as well. Traditionally they are extracted via intraoral approaches (transpalatal or vestibular). Also, an endoscopically assisted transnasal approach can be used. In this paper, the authors are the first to present a group of patients suffering from impacted mesiodentes who have been surgically treated using a modified maxillary vestibular approach with subperiostal intranasal dissection.
The prospective study was completed in the time period 12/2013–6/2017. The inclusion criteria were: 1. Mesiodens impacted in the inverted position extending to the base of the nasal cavity or into the nasal septum without concomitant pathological lesion and without eruption into the nasal cavity. 2. Localization of the mesiodens at the level of or dorsally to the roots of the upper middle incisors in the sagittal plane or ventrally to the roots of these teeth, but with the crown extending significantly posteriorly to the base of the nasal cavity.3. Indication for extraction because of clinical or orthodontic reasons.
In total, 9 patients were enrolled into the group. In these patients, surgical extractions of 9 mesiodentes were performed using the alternative approach described above. All extractions were done according to a uniform surgical protocol. The mean age of the patients was 11.7 ± 3.1 years (age range 7–17 years). The crown's most cranial point exceeded the bone of the nasal cavity on average by2.0 ± 1.4 mm (in the range 0–5 mm). 8 mesiodentes were conical, 1 was tuberculate. Surgical procedure and postoperative healing were always without any complications.
For the removal of midline supernumerary teeth, the modified maxillary vestibular approach with subperiostal intranasal dissection in comparison to the intraoral palatal approach provides less postoperative morbidity and a lower risk of complications (smaller surgical wound, minimal exposure of maxilla, minimal bone loss, reduced risk of damage to the roots of the upper incisors, lower risk of damage to the nasopalatine neurovascular bundle, good visibility in the surgical field, easier surgery, and finally no need of postoperative palatal splint). For oral and maxillofacial surgeons the presented technique represents a more traditional way of surgical tooth extraction than the endoscopically assisted transnasal approach.
Dentigerous cyst associated with a supernumerary tooth in the nasal cavity: A case report
2015, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
There have been some reports concerning supernumerary teeth located in the maxilla; however, eruption into the nasal cavity leading to a dentigerous cyst is quite rare. The authors report a 6-year-old boy who was noticed to have a foreign body in the right nasal cavity during a school physical examination. There was no subjective nasal symptom, such as bleeding or a feeling of rhinostenosis. On radiological examination, a tooth-like radiopaque object was noted beneath the surface of the right nasal floor, and part of a supernumerary tooth in the left maxillary incisor area was also seen. Ectopic supernumerary teeth were diagnosed and removed under general anesthesia. Histopathological examination identified the tooth-like structure as a mature tooth, and the isolated tissue in the nasal cavity was coated by soft tissue, confirmed as a feature of a cyst.
Three years after surgery, the patient was doing well and had healed uneventfully.
Supernumerary nasal tooth in close proximity to a dental implant
2014, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
In the latter theory, the crowded complete dentition triggers hyperactive proliferation of the epithelial remnants of the dental lamina near a permanent tooth bud, which leads to formation of an additional tooth bud.1,5 The spatial orientation of SNT is variable, and it has been proposed that they are a special case of mesiodentes that are inverted and thereby erupt into the floor of the nasal cavity.4 The cause of SNT is unclear, but proposed theories include obstruction at the time of tooth eruption owing to crowded dentition, exceptionally dense bone, genetic predisposition, developmental abnormalities such as cleft palate, rhinogenic or odontogenic infection, or displacement from trauma or cyst.6
Supernumerary nasal teeth (SNT) are a rare phenomenon. Supernumerary teeth occur in 0.1 to 1% of the population. They are most commonly found in the upper incisor area, when they are known as mesiodentes. They also are fairly common elsewhere on the intraoral palate and in the maxillary sinus. Nasal teeth are quite rare, with only case reports and small case series found in the literature. SNT can present with different symptoms, including unilateral nasal obstruction, nasal drainage, and infections, or they can be asymptomatic and found incidentally. This report describes a case of a nasal tooth in close proximity to a noninfected dental implant that became symptomatic with unilateral nasal obstruction. The diagnosis was based on endoscopic and radiologic findings, and the patient’s symptoms resolved after endoscopic surgical removal of the tooth through the nasal cavity.
Endoscopic removal of bilateral supernumerary intranasal teeth
2012, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Therefore we investigated supernumerary intranasal teeth in the English-language literature. The review of Kirmeier et al4 between January 1959 and January 2008 and our further investigation until July 20115 showed 26 well-documented cases of supernumerary intranasal teeth, including the present case and the case of Kirmeier et al. The age when the supernumerary intranasal teeth were diagnosed ranged from 6 to 61 years (mean, 25.8 ± 13.4 years).

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Case ReportOral SurgeryThe supernumerary nasal tooth

Abstract

Section snippets

Clinical case

Review of the literature

Discussion

Disclaimer

Competing interests

Funding

Ethical approval

Acknowledgement

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Int J Pediatr Otorhinolaryngol

Ann Anat

Oral Surg Oral Med Oral Pathol

Dentigerous cyst from supernumerary tooth in the nasal cavity

J Indian Dent Assoc

Die überzähligen oberen Incisivi des Menschen

Dtsch Mschr Zahnheilk

Nasal teeth: report of three cases

Am J Neuroradiol

Minor terata - anomalies of the teeth

Supernumerary tooth in the floor of the nose

J Laryngol Otol

Ectopic supernumerary tooth in the nasal cavity

J Laryngol Otol

A case of an inverted tooth in the nasal cavity

Auris Nasus Larynx

A nasal tooth associated with septal perforation: A rare occurrence

Eur Arch Otorhinolaryngol

Case Report
Oral Surgery
The supernumerary nasal tooth