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BACKGROUND The avulsion of the impacted lower third molar is one of the most common procedures in oral surgery. Even though it is characterized by possible complications due to the lesion of lingual and inferior alveolar nerves, the intra-oral surgical approach represents the first choice strategy when planning surgery. However, in case of ectopic tooth in the mandibular basal bone, it is appropriate to consider an extra-oral transcutaneous surgical approach. The ectopia of the inferior wisdom tooth represents a very rare clinical condition and sometimes it is even unknown by patients and dentists: further evidence of this fact is represented by the paucity of paper related to the topic that can be found in the international scientific literature. METHODS The experience of the Department of Maxillofacial Surgery of San Gerardo Hospital in Monza (Italy) in management and treatment of ectopic impacted lower third molar is exposed through the presentation of three cases of ectopic third molar. RESULTS Two out of three patients, aware of the risks related to the surgical procedure, refused the treatment proposed. One patient underwent surgical avulsion of the wisdom tooth through extra-oral transcervical approach. No early or late complications have been observed. CONCLUSIONS Extra-oral surgical approach for ectopic lower third molar should be considered for selected cases. Given the rarity of the clinical condition and the procedure-related risks, accurate pre-operative information has to be provided to the patient by physician and the procedure should only be performed by expert and competent surgeons.

BACKGROUND: Nowadays, cone beam computed tomography (CBCT) are commonly used in dentistry with an advantage about significantly lower dose comparing with CT-Scanner. Utilizing CBCT images which are indicated in dentistry like orthodontics can help diagnose diseases beyond dentistry field. One rare phenomenon can be seen in maxillary sinus, which is often overlooked by dentists, is ectopic teeth. CASE REPORT: This article describes one orthodontic case found accidentally an ectopic tooth in maxillary sinus by inspecting CBCT images. CONCLUSION: Dentists and oral radiologists should carefully inspect non-dental structures, like maxillary sinus, even its distance from the dentoalveolar region, especially in asymptomatic patients.

Dentigerous cysts are characterised by the formation of cysts containing dental material with a variable level of development. They are the result of a distinct embryological phenomenon. Usually, they are of significant clinical relevance in horses, especially in tandem with ectopic tooth. Contrarily, supernumerary teeth or typical polyodontias usually have limited impact. In this case report, we describe the occurrence of a supernumerary first premolar (Triadan 105). Dissimilar to known scientific literature however was the formation of a cystic structure around the supernumerary tooth. Surgical removal of the dentigerous cyst is discussed, as are the possible causes for the formation of the cystic structure. Based on this case report, we suspect that the formation of a cystic structure may not be limited to atypical polyodontias, as they may also occur in supernumerary teeth.

This case series describes an alternative approach for removing ectopically erupted tooth in the maxillary sinus using an improved endoscopic approach known as modified endoscopic-assisted sinus surgery (MESS). We reviewed medical charts and radiographs of patients who underwent surgical removal of an ectopic tooth in the maxillary sinus using MESS. The surgical technique consisted of creating a bony window in the maxillary sinus wall with a pre-adapted microplate, which was repositioned after the tooth was removed. For all the patients included in this study, there were no postoperative complications clinically and radiographically. At the time of microplate removal, satisfactory bone regeneration was observed around the bony window margins of the maxillary sinus wall. MESS is an effective technique that modifies and integrates the techniques of the conventional Caldwell-Luc procedure (CLP) and functional endoscopic sinus surgery (FESS) and can be used to remove ectopic tooth in the maxillary sinus by avoiding the risk of postoperative sinus-related complications.

Ghost images are artefacts of anatomical structures or foreign objects that oral and maxillofacial surgeons should take into consideration to prevent misdiagnosis and mistreatment. A 38-year-old male patient referred to our clinic for dental implant treatment. Orthopantomograph (OPG) revealed an impacted distomolar at the apex of maxillary right third molar and an ectopic supernumerary tooth in the left maxillary sinus. Despite the ectopic supernumerary tooth appearance on OPG, cone beam computed tomography images revealed that there was not a supernumerary tooth in the left maxillary sinus. Nasal cavity and paranasal sinuses in field of view were evaluated and maxillary ostium diameters were measured to detect if the tooth had migrated. The tooth appearance on the OPG was determined as a ghost image of the impacted distomolar at the contralateral side. Following the extraction of the distomolar, another OPG was performed and the ghost image was disappeared.

Ectopic teeth in the nasal cavity are a rare phenomenon. They are often associated with a variety of symptoms and future complications, ranging from nasal crusting and obstruction to chronic infections. In most reported cases, their removal is recommended. Here, we report a case of an ectopic intranasal tooth in a symptomatic adult. The tooth was removed endoscopically with good results.

Objective This study was performed to investigate the process of ectopic tooth formation. Methods A patient with an ectopic tooth was followed for 6 years. The tooth size and mineralization were evaluated by paranasal sinus computed tomography every 3 years. Results The ectopic tooth was present in the nasal crest of the maxilla and did not change significantly during the 6-year follow-up period. However, the patient developed a new ectopic tooth in the maxillary sinus (ETm). This tooth, located in the posterior wall of the left maxillary sinus, initially appeared as a small region of soft tissue on computed tomography. After 3 years, the area of mixed density had significantly increased, and some of it had significantly mineralized to form an ETm. After 6 years, the ETm had further mineralized and enlarged in situ. The width between the left and right sides of the ETm in 2018 (9.08 ± 2.09 mm) was significantly larger than that in 2015 (7.51 ± 2.18 mm), indicating that ETm formation is a gradual process of mineralization. Conclusion Ectopic teeth can gradually form by in situ mineralization after adolescence, suggesting that ectopic teeth are genetically regulated and result from a programmed formation process occurring at a specific time point.

Objectives:Supernumerary dentition has been found to occur in various areas of the head and neck. Although they are commonly found along the dental arch, there are some instances of ectopic supernumerary teeth found elsewhere in the upper aero digestive tract. This case report details an impacted molar tooth in the orbital floor.Methodology:We present an unusual case of a 30-year-old male with a chief complaint of nasal obstruction. Clinically, it was manifested with an impacted molar in the orbital floor with associated bony expansion into the maxillary and ethmoid sinuses.Results:Radiographically, CT scan revealed a benign appearing expansile mass in the left maxilla, completely occupying the sinus and extending into the nose and expanding laterally into the cheek. There appeared to be a well-formed tricuspid tooth clearly visible at the top of this lesion protruding into the left orbit. The patient underwent endoscopic surgical removal, showed findings of an impacted tricuspid in the medial and inferior walls of the orbit. Histopathologic examination confirmed a large cyst lined by thick stratified squamous epithelium and embedded with dense fibrous connective tissue, consistent with an orthokeratinized odontogenic cyst. The medial orbital wall was decompressed, and his postoperative course was uneventful with no orbital complications. Ectopic supernumerary teeth are unusual findings, particularly in association with the orbit. They are frequently impacted and as such can lead to the development of cystic lesions. As with other odontogenic cysts, surgery is usually definitive. This case study demonstrates complete removal with endoscopic surgery.

Highlights • Ectopic teeth are commonly seen in palate. • The pathogenesis of ectopic teeth eruption is not fully recognized. • In children, intranasal ectopic teeth occur more frequent in patients with cleft lip and alveolus. • Most cases of the ectopic tooth are asymptomatic and identified incidentally. • The management of the ectopic teeth is tooth extraction., Introduction Intranasal teeth are a rare form of ectopic teeth. Their clinical manifestation are truly variable. In children, intranasal teeth are typically associated with cleft lip and alveolus. Presentation of case Here, we report a case of 11 years –old girl presented with right nasal obstruction and occasional headache without any obvious etiology. 0Computed tomography of the paranasal sinuses (coronal and axial view) revealed displaced right upper maxillary tooth with the crown oriented inferiorly and medially toward and within the lower right anterior nasal cavity. She underwent surgery by anterior rhinoscopy and endoscopic guidance. The patient’s symptoms were resolved completely post-operatively and remained symptom-free for 18 months postoperatively. Discussion Ectopic intranasal tooth is a rare phenomenon, with a male predominance and around half of all patients are diagnosed before adulthood. Ectopic intranasal tooth arising from inferior turbinate is very rare. No clear etiological factor has been suggested in most of the reported cases. Idiopathic etiology has been described as an etiologic factor for ectopic teeth. The treatment of intranasal teeth is early surgical extraction to alleviate the symptoms and prevent the possible morbidities. Conclusion Intranasal teeth are a rare form of ectopic teeth encountered to otolaryngology clinic and may cause a variety of symptoms and complications. CT is very useful; it confirms the diagnosis and facilitates surgical planning. Early diagnosis and treatment are very important to avoid their possible complications.

This case report highlights mandibular tooth in an ectopic position in the floor of the mouth, associated with submandibular salivary gland, which was completely obliterating the Wharton duct. Very few such cases have been reported in the literatures. Since ectopic tooth may lead to pain, discomfort sensation upon mastication, and even infection (sialadenitis), its diagnosis and treatment is essential.

The aim of this case report is to present an original conservative technique for the transnasal endoscopy-assisted extraction of an ectopic upper third molar associated with a dentigerous cyst occupying the whole maxillary sinus by means of combined lower and middle meatotomies. The proposed technique is a viable, minimally-invasive alternative to the Caldwell–Luc operation (with or without the repositioning of a bone lid), and also to endoscopic middle meatal antrostomy in cases where this would be unable to ensure adequate access because of the position and size of the ectopic tooth and associated cyst.

Rhinolith is a calcified irregular mass around an exogenous or endogenous nidus. Factors responsible for the formation of rhinolithare chronic inflammation around nidus, deposition of mineral salts and enzymatic activity of bacterial pathogens. We report the caseof a 53-year-old patient with a hard radio-opaque mass in the nasal cavity and complaints of nasal obstruction and foul-smelling nasaldischarge. On imaging, it was found out to be formed around an ectopic single cusp tooth in the nasal cavity and which is rarest.Endoscopic removal was performed and the patient was relieved and asymptomatic after the procedure. Hence, endogenous etiologyof the ectopic supernumerary tooth should be kept in mind.

Ectopic tooth eruption in a non-dental area is a rare entity, and is most common in oral cavity. There have been a few case reports of teeth erupting in mandibular condyle, chin, palate, coronoid process, and maxillary sinus. Ectopic tooth in the maxillary sinus are found incidentally on routine radiological examination, same time they can be symptomatic and associated with pathologies usually dentigerous cyst or odontogenic keratocyst. Facial pain, purulent rhinorrhoea, epistaxis, headache, swelling, and epiphora-related naso-lacrimal duct obstruction can also be seen. By Caldwell-Luc procedure the ectopic teeth within the maxillary sinus are often removed. In this study, a case of ectopic maxillary third molar tooth on right maxillary sinus is presented.

Dentigerous cysts in the craniomaxillofacial complex are a benign pathology commonly associated with ectopically placed teeth. Owing to slow and asymptomatic growth, they often attain considerable size before diagnosis that may compromise adjacent anatomical structures. Various techniques for removal of dentigerous cysts from the maxillary sinus have been described. This case report demonstrates a hybrid endoscopically assisted modification of the Caldwell-Luc approach to provide the technical advantages of both techniques.

The aim of this study was to report two rare cases of ectopic tooth into the nasal cavity. The first case reports a 32-year-old female patient with the main complaint of having a tooth inside her nose. According to her, this condition causes pain and sporadic nosebleed. The patient had a facial trauma when she was 6 years old. The second case refers to an 8-year-old girl with left incomplete unilateral cleft lip and palate. The main complaint was left-sided nasal obstruction by a white hard mass. The treatment for both cases was surgical removal of the ectopic erupted tooth under general anesthesia. In conclusion, we can state that the surgical removal of intranasal tooth is a safe procedure and improves patient’s quality of life.

A 16-year-old male patient reported to our department with a chief complaint of pain and swelling in the upper left cheek region. On examination, a maxillary canine was found ectopically in the anterior wall of maxillary sinus. Ectopic eruption of teeth into regions other than the oral cavity is rare. We present one such case of ectopic eruption of maxillary canine.

Background: Ectopic eruption of a tooth or osteoma rarely occurs within the maxillary sinus. Coexistence of these two rare entities in the maxillary sinus has never been reported in the English literature. Case Report: Herein, we present a 21 year-old male patient with osteoma and ectopic tooth in the left maxillary sinus treated with the removal of the ectopic tooth by endoscopic sinus surgery and excision of the osteoma by the Caldwell- Luc procedure. Conclusion: Unique coexistence of two different entities in the maxillary sinus is most likely due to pediatric facial trauma. Pediatric patients with maxillofacial trauma should be carefully watched for dental injury both clinically and radiologically.

Purpose: Ectopic tooth within the tooth bearing region is often noticed in clinical practice but ectopic eruption in non-dentate regions like maxillary sinus is rare. Rarer is the presence of multiple ectopic teeth involving both the maxillary incisors and canine and has not been reported yet. Method: A seventeen year old male presented with a complaints of dull pain on the right side of the face for past two years. Water’s view X-ray of PNS revealed dense non-specific opacification of the right maxillary sinus. Result: Antrostomy through Caldwell–Luc approach revealed three ectopic teeth in the right maxillary sinus. Later the teeth were identified to be central incisor, lateral incisor and canine. Conclusion: Rare finding of ectopic incisors in the maxillary sinus is reported and the need for interdisciplinary approach to patients is stressed upon.

The eruption of tooth other than the alveolar arch is called Ectopic Tooth. It is frequently encountered in the maxillary sinus. Facial pain is the most common presentation which is commonly misdiagnosed as chronic sinusitis. We present a case of a 47-year-old lady who was incidentally diagnosed to have an ectopic free lying canine in the maxillary sinus and discuss the various theories mentioned in literature predisposing to this condition.

Nasally ectopic teeth are rare, but can be a source of significant morbidity. Symptoms can include facial pain, nasolacrimal duct obstruction, fungal rhinitis, persistent rhinorrhea and episodic epistaxis. A nasally ectopic tooth should be considered as a differential diagnosis for a radiopaque lesion within the nasal cavity. This case illustrates the diagnosis and subsequent minimally traumatic recovery of a nasally ectopic tooth, believed to be an upper first premolar tooth, via an endoscopic approach.

A 27-year-old woman was referred to neurology from her family physician’s office for evaluation of her seizures. The patient also had chronic headaches that were refractory to standard medical treatment. She described these as unilateral (right-sided), throbbing, of moderate to severe intensity

Background: Rhinoliths are rare affections of the main nasal cavity and the paranasal sinuses. Initially, as a result of their low incidence, they are often incorrectly classified as calcified tumors in clinical examination. Methodology: We have identified three cases in our patient population and evaluated the clinical symptoms as well as the pathological findings and the causes of the disease. Results: Due to their extension and the respective clinical pattern, all masses were surgically removed under endotracheal anesthesia. The histopathological findings comprised an ectopic tooth, a vegetable (most likely a leaf from the garden) as well as a textile foreign body (probably of iatrogenic origin). Conclusion: Undiscovered foreign bodies of the main nasal cavity are a common cause for the formation of rhinoliths. We have also displayed the respective incidence and the therapeutic options.

Dental injury is one of the most common complications of tracheal intubation. Although teeth dislodged during tracheal intubation are usually found in the oral cavity, we encountered a case of a missing tooth found in the nasal cavity in an intubated patient. A 62-year-old man with 4 loose teeth in the upper jaw was scheduled for laparoscopic hernia repair. After our second attempt at insertion of a nasogastric tube via the left naris, we discovered that a tooth had been dislodged. A lateral-view radiograph revealed the dislodged tooth in the nasal cavity. The ectopic tooth was removed by an otorhinolaryngologist.

Intranasal ectopic tooth, which can be derived from either supernumerary, deciduous or permanent tooth, is generally a rare event. Their existence can cause a wide array of complication such as epistaxis, nasal blockage, nasal pain, rhinosinusitis, septal deviation, septal abscess as well as oronasal fistula. We highlight a case of a canine supernumerary tooth that erupted at floor of nasal cavity, causing an acute unilateral nasal blockage, and managed successfully with an endoscopic nasal tooth extraction.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 235-237

A 40-year-old female patient presented to ears, nose and throat complaining of cacosmia and discharge from the left maxillary sinus. Her CT scan revealed an ectopic supplemental nasal tooth which could not be removed by nasoendoscopy. Therefore, a conventional intraoral surgical approach was taken. In this case, we discuss the indications for conventional surgical removal of teeth from the nasal cavity when a nasoendoscopic approach is not possible. We highlight the potential pitfalls of both conventional and nasoendoscopic approaches, including some essential considerations when treatment planning these cases.

Odontogenic keratocyst is an aggressive cystic lesion and a common type of tooth derived cyst due to presence of odontogenic epithelial remnants in different regions of jaw. In majority of cases, it is located in mandibular posterior region. But it can also be found in the maxilla especially in the canine region. We present a rare case of OKC in maxillary sinus which associated with ectopic third molar. Also, it can be easily confused with other lesions of maxillary sinus like sinusitis or antral polyps, which usually resemble symptomatically. There can be malignant transformation of this benign condition towards squamous cell carcinoma or ameloblastoma. So an early and accurate diagnosis of odontogenic keratocyst is a challenge for pathologists.

An ectopic tooth in the nasal cavity is a rare phenomenon, especially on the inferior turbinate. In most of the reported cases, no etiological explanation of the intranasal teeth has been suggested or found. In children, intranasal ectopic teeth are usually associated with cleft lip and alveolus. Here, we report a rare case of a pediatric patient with unilateral nasal obstruction due to an intranasal ectopic tooth originating from the inferior turbinate without any facial and dental deformities. This case is unique due to the unusual location of the ectopic tooth and its presentation in a child without facial and dental deformities.

Abnormalities in tooth morphology and number are not uncommon. However, an exact clone of a normal tooth is a recondite clinical finding. Presence of supplementary teeth is mostly noticed in maxillary anterior, molar or premolar region, followed by mandibular premolar region in descending order of its site of occurrence. Supplemental tooth in mandibular anterior has a low prevalence of 0.01%. This paper reports one such rare case of nonsyndromic incisive jumeaux in mandibular anterior region during mixed dentition period.

Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature. But the ectopic eruption into the non dentate region is rare and scantly documented. The maxillary sinus is one such a non dentate region, apart from nasal septum, mandibular condyle, coronoid process and the palate, to accommodate such ectopic eruptions of teeth. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature and discussed. Early surgical intervention for removal of ectopic tooth along with enucleation of the associated cyst, if any, is the treatment of choice.

Dentigerous cysts are commonest type of developmental, epithelial-lined, odontogenic cysts arising in the jaw from the crowns of impacted, unerupted or embedded tooth, most often third molar. But dentigerous cysts arising from ectopic tooth in maxillary sinus is quite rare. Ameloblastoma changes in the dentigerous cysts are rare and to the best of our knowledge have not been reported to be arising from ectopic tooth in maxillary antrum. In this article, we present the radiological diagnosis, clinical features and management of this rare case of ameloblastic transformation in dentigerous cyst arising from ectopic tooth in maxillary antrum.

Dentigerous cysts are the most common type of developmental odontogenic cysts arising from the crowns of impacted, embedded, or unerupted teeth. They constitute about 20% of all epithelium-lined cysts of the jaws. The teeth involved most often are mandibular third molar and maxillary canines. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla. Dentigerous cysts associated with ectopic teeth within the maxillary sinus are fairly rare, and only 20 cases had been reported in Medline since 1980. In the present paper, we report an additional case of dentigerous cysts associated with ectopic third molar in the right maxillary sinus. Also, pathogenesis of ectopic tooth, role of advanced imaging, differential diagnosis, and management are discussed.

An intranasal tooth (INT) is an ectopic tooth erupting into the nasal cavity. It is a rare clinical entity. Ectopic and supernumerary teeth may be present in many regions of maxillofacial skeleton. Ectopic teeth may be supernumerary, deciduous or permanent. The clinical manifestations of intranasal tooth are quite variable and they may cause a variety of symptoms and complications. Their clinical and radiographic presentations are classical, posing little challenge to the diagnostician. The identification of such teeth can be important since they have potential to cause considerable morbidity. Here, we describe a case of intranasal tooth along with possible etiopathogenesis, clinical and radiographic features, differential diagnosis, potential complications and treatment modalities.

Dentigerous cyst is known to be caused by the accumulation of fluid between the epithelium and the crown of an unerupted tooth. Its size increases by the expansion of the follicle, and it is attached to the neck of the tooth. These cysts are often associated with impacted third molars and maxillary canines and rarely with supernumerary teeth. In the present paper, we report a case of a dentigerous cyst associated with an impacted ectopic supernumerary tooth. This cyst was missed initially due to a failed root canal treatment associated with the nonvital maxillary central incisor. This case of a cystic lesion can create a dilemma between radicular and dentigerous cyst. The pathogenesis of the ectopic tooth, differential diagnosis, and management are also discussed.

A 30-year-old female patient reported to the dental clinics with a complaint of missing teeth. On clinical evaluation maxillary left pre-molars and mandibular left second molar were absent, the patient was free from any gross pathology and a set of radiographs was advised for analysis of periodontal health and treatment planning. Radiographs revealed the presence of an impacted 3rd molar tooth in the left coronoid process [Table/Fig-1], though clinically no signs or symptoms were observed. Since the location of tooth was abnormal the case was diagnosed as “ectopic 3rd tooth in coronoid process”. [Table/Fig-1]: Orthopantomogram showing ectopic 3rd molar in left coronoid process As the literature suggests such asymptomatic patients can be kept under regular follow-up without any surgical intervention till there is any associated pathology or discomfort. The patient was motivated for placement of implants in edentulous areas and was informed regarding the presence of the ectopic tooth. All the possible complications which could arise in relation to the ectopic tooth were explained to the patient. Further, the patient was advised to have a regular follow-up and visit the dental clinics in case even slight discomfort arose in the concerned region. Occurrence of impacted 3rd molar tooth is not uncommon but an impacted 3rd molar tooth in an abnormal location (ectopic tooth) is not encountered very frequently [1]. As per the reviews very few cases of ectopic 3rd molar tooth have been reported in English literature [1,2]. Hence, it becomes difficult to comment about the epidemiology of these ectopic teeth. The aetiology of this phenomenon also remains obscure, though many theories have been put forth to explain this exceptional event [2]. This paper presents a case of an ectopic tooth in coronoid process. Only 6 cases of this condition have been reported till date, thus the current case is another milestone of this rare occurrence [1]. A tooth may be impacted, by soft tissue alone or it might be a bony impaction, but the location of the tooth is close to its physiologic position [3]. When such impacted teeth have dislocated to distant regions such as condylar process, mandibular ramus, maxillary sinus, nasal cavity etc these are referred to as ectopic teeth [1,2]. Keros and Susic referred to this condition as “Heterotopic position of tooth” in his report [4]. Occurrence of ectopic tooth as such is an uncommon phenomenon and ectopic tooth in coronoid process is even rarer [1], the latter scenario was observed in the current case. It is not always possible to determine the exact cause of an ectopic tooth. Various authors have suggested different possible aetiologies which may be either pathologic such as cysts, developmental like an abnormal eruptive pattern or tooth germ development in abnormal location, or sometimes traumatic or iatrogenic in nature [1,2]. In the present case the causative factor appears to be developmental aberration since there was no associated pathology or any history of trauma or surgical interventions in relation to the jaws. Due to the sporadic nature it is not appropriate to definitively comment about the gender predilection, site, clinical signs and symptoms, etc of ectopic 3rd molars. Most of the reported cases in literature are in women and located in mandibular subcondylar or condylar region [1]. In present case too patient was a female but the tooth was located in an atypical position i.e. the coronoid process [Table/Fig-1]. The clinical symptoms may be in the form of pain and swelling, trismus or sometimes fever with acute inflammation and draining sinus [2]. In the case under discussion the patient was asymptomatic and it was an incidental finding. Asymptomatic cases are generally kept under regular follow-up with radiographic evaluation, as was done in the current case. Ectopic tooth associated with cysts are generally surgically treated conservatively until the cyst is very small. In latter case patient is kept under regular follow-up with radiographic evaluation as is done in asymptomatic cases. Intraoral approach is preferred if possible to avoid scarring of facial skin [5]. Based on various reported cases and reviews of ectopic tooth it can be said that coronoid process is not a common location for occurrence of this phenomenon. Further, it is a must that asymptomatic cases are kept under regular follow-up to monitor the development of any new symptoms or pathology or observe any increase or decrease in the associated pathology.

Volume 3 | Issue 4 Supernumerary Ectopic Tooth in Nasal Cavity A Case Report Ahmed Z*1 and Zubair S2 1Professor of ENT, Shalamar Medical & Dental College, Lahore, Pakistan 2House Officer, CMH-Medical & Dental College Lahore, Pakistan *Corresponding author: Ahmed Z, Professor of ENT, Shalamar Medical & Dental College, Lahore, Pakistan, Tel: +92-3344551285, E-mail: zubmedke@hotmail.com Case Report Open Access

Ektopik dişler diş ve ağız harici lokalizasyonlarda nadiren tarif edilmişlerdir. Maksiller sinüs içinde ektopik diş çıkması, asemptomatik olması nedeniyle sıklıkla rutin radyolojik ve klinik değerlendirme sırasında tesadüfen karşılaşılır. Eğer maksiller sinüs içinde ektopik diş çıkması semptomatik oluşursa; pürülan rinore, yüz ağrısı, başağrısı, şişme, epistaksis ve epifora gibi bulgular görülebilir. Çoğunlukla Caldwell-Luc prosedürü ile tedavi edilir. Bu çalışmada, sağ maksiler sinüste ektopik maksiller üçüncü molar diş olgusu sunuldu, Ectopic teeth have been rarely described in non-dental and non-oral localizations. Ectopic tooth eruption in maxillary sinus usually runs across incidentally during routine radiological or clinical evaluation because it is generally asymptomatic. If it occurs symptomaticaly; the findings like purulent rhinorrhoea, facial pain, headache, swelling, epistaxis and epiphora can be seen. It is often treated via Caldwell-Luc procedure. In this study, a case of ectopic maxillary third molar tooth on right maxillary sinus is presented.

Summary Rhinolith describes the pathology which is formed by means of deposition of salts on an organic or inorganic nidus in the nose. A nidus may be endogenous or exogenous. A rinolith may develop on an endogenous nidus such as dried blood clots, desquamated epithelium, dried purulent material, bone fragments and rarely ectopic tooth. A 23-year-old male patient presented to our clinic with one-sided nasal obstruction, nasal discharge and deformity of nose. Anterior rhinoscopy, nasal endoscopy and computed tomography (CT) scan revealed a rinolith in the right nasal cavity. In this case, preoperative CT scan and postoperative histological examination revealed that the nidus of the rhinolith was an intranasal ectopic tooth. We herein discuss ectopic tooth as a rare cause of rhinolithiasis.

Only few cases of ectopic third molar in relation to the roof of maxillary sinus and posteroinferior to the floor of the orbit have been reported in the literature. The diagnosis is usually done by plain-film radiography. "Caldwell-Luc" operation or endoscopic procedures have been used for the removal of such type of ectopic tooth. We report a case of 46-year-old female patient who presented with pain, swelling and watering of eye due to the ectopic tooth. The trans oral removal (via "Caldwell-Luc" operation) of the ectopic maxillary third molar situated superior to maxillary antrum and posteroinferior to the floor of orbit has been described in this case without any complication.

A 23 year-old-woman was referred to point out for pain on the left side of her face and mucopurulent rhinorrhoea lasting for 07 months with long history of recurrent sinusitis. Antibiotics and pain-killers were prescribed to him in the first time. On examination of the oral cavity, all the permanent teeth were present. At nasal endoscopic examination we found a mucopus trickling from the left middle meatus.clinical diagnosis is for sinusitis of dental origin, fungal sinusitis or chronic rhinosinusitis Coronal computed tomography (CT) of the paranasal sinuses revealed the presence of a supernumerary molar tooth (Arrow) within left maxillary sinus floor (A). The tooth was extracted by traditional approach (Caldwell-Luc procedure) from the maxillary sinus under general anesthesia (B, C, D), and the patient has been asymptomatic for more than 02 years. The presence of ectopic or supernumerary tooth in the maxillary sinus is most often asymptomatic but on rare occasions can be a cause of recurrent sinusitis. The supernumerary ectopic tooth is a very rare condition, usually it's localized on the maxillary sinus, and other sites were described like nasal cavity or chin. Coronal computed tomography is sufficient to determine extract localization. The extraction can be made by conventional approach or by transnasal endoscopic approach with less morbidity.

We describe a case of an incidentally-diagnosed ectopic tooth showing anomalous morphology in the maxillary antrum, using three-dimensional reconstruction of computed tomography images of the tooth obtained by multi-detector computed tomography.