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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 53-56

Ectopic tooth in maxillary sinus: A case series


Oral and Maxillofacial Surgery, Department of Dentistry, AIIMS, Patna, Bihar, India

Date of Submission07-Mar-2022
Date of Acceptance22-Apr-2022
Date of Web Publication29-Jun-2022

Correspondence Address:
Dr. Haidry Naqoosh
Oral and Maxillofacial Surgery, Department of Dentistry, AIIMS, Patna 801507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_8_22

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  Abstract 

Ectopic tooth eruption in the dentate region of the jaws is common in clinical practice and is well described in the literature. Ectopic eruption into the nondentate zone, on the other hand, is uncommon and poorly described. Apart from the nasal septum, mandibular condyle, coronoid process, palate, the maxillary sinus is one such nondentate area that may contain such ectopic tooth eruptions. The incident hence ought to be added to the literature and analyzed because of its rarity and lack of consensus on its management. The treatment of choice is early surgical removal of the ectopic tooth, as well as enucleation of accompanying cysts, if any.

Keywords: Caldwell luc approach, dentigerous cyst, ectopic tooth, maxillary sinus


How to cite this article:
Vivek K, Naqoosh H, Aiswarya V, Ameera S, Vyakhya G. Ectopic tooth in maxillary sinus: A case series. Int J Oral Care Res 2022;10:53-6

How to cite this URL:
Vivek K, Naqoosh H, Aiswarya V, Ameera S, Vyakhya G. Ectopic tooth in maxillary sinus: A case series. Int J Oral Care Res [serial online] 2022 [cited 2022 Aug 16];10:53-6. Available from: https://www.ijocr.org/text.asp?2022/10/2/53/348774




  Introduction Top


Ectopic eruption can be caused by one of three things: developmental disruption, iatrogenic activity, or a pathologic condition like a tumour or cyst.[1],[2] The developing tooth migrates from its intraosseous location in the jaw to its functional position within the mouth cavity during tooth eruption. Ectopic eruption is one of the many eruption issues that can emerge during the transitional dentition era.[3] With the establishment of dental lamina in the sixth week of intrauterine life, deciduous tooth development begins. Between the 5th and 10th postnatal months, the ectodermal layer begins to create the permanent dentition.[4] It is a multistep process in which the interaction of the oral epithelium with the underlying mesenchymal tissue is crucial. Ectopic tooth development and eruption can occur as a result of abnormal interaction at any stage. Ectopic eruption of a tooth within the dentate region, which is more common in the mandible and among females, is frequently seen in clinical practice. The teeth that are most affected are the incisors, canines, and premolars.[5] However, a situation like this in a non-dentate location like the maxillary sinus is quite rare. Because of its rarity, the incident deserves to be documented and examined.[6],[7]


  Case Reports Top


Case 1

A 10yr old boy reported to Department of Dentistry, AIIMS Patna with chief complain of swelling in upper left since 2 months. The swelling had started off abruptly after an episode of trauma to the region and has been of the same size ever since. On extraoral examination, a bony hard diffuse non tender swelling was present in left maxillary region. Overlying skin appeared normal. Intraoral examination revealed presence of a dome shaped swelling in the upper left vestibular region of size approx. 3 x 2 cm with expansion of buccal cortex and palatal cortex extending from 21–26 region. On palpation the swelling was non tender, bony hard and non-compressible. On aspiration a straw coloured aspirate was found. CECT revealed presence of ectopic tooth in the sinus associated with cystic lesion causing expansion of cortices. There were no abnormal findings in the general examination. The cyst was enucleated along with the tooth from the maxillary sinus using Caldwell Luc approach under General Anaesthesia and the sample was sent for histopathological examination which confirmed the presence of dentigerous cyst associated with ectopic tooth. Postoperative period of the patient was uneventful [Figure 1].
Figure 1: Case number 1: (A) extraoral view, (B) intraoral view showing vestibular obliteration, (C) intraoral view showing palatal swelling, (D) CECT revealed the presence of a lesion in the right maxillary sinus associated with an ectopic tooth, (E) intraoral operative procedure, and (F) gross specimen picture

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Case 2

A 32yr old male reported to Department of Dentistry with chief complain of swelling in right side of face since 3 months. The swelling started abruptly 3 months back, was smaller in size initially but increased in size over a period of 3 months to reach the current dimension. On extroral examination, face was bilaterally asymmetrical with a diffuse swelling present on right side of face, the swelling was soft and non tender on palpation,overlying skin appeared normal. Introral examination revealed obliteration of vestibule in the region of 16,17 region. There were no abnormal findings in the general examination. CECT revealed presence of a lesion in the right maxillary sinus associated with an ectopic tooth causing erosion of surrounding bone. The cystic lesion was enucleated along with the ectopic tooth under general anesthesia using Caldwell Luc approach and the sample was sent for histopathological examination which revealed the presence of dentigerous cyst associated with ectopic tooth. Postoperative period of the patient was uneventful [Figure 2].
Figure 2: Case number 2: (A) extraoral view, (B) intraoral view showing vestibular obliteration, (C) CECT revealed the presence of a lesion in the left maxillary sinus associated with an ectopic tooth, and (D) gross specimen picture

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Case 3

A 22yr old female reported to Department of Dentistry with chief complain of swelling in right side of face since 4 months. Patient had visited multiple private clinics with the same chief complain where she was prescribed antibiotics but did not got any relief, finally she reported to Department of Dentistry,AIIMS Patna. On extraoral examination a diffuse swelling extending superioinferiorly from the infraorbital margin to the angle of mouth and mediolaterally from the right ala of the nose to the region of zygomaticotemporal suture was present on right side of face causing facial asymmetry. On palpation the swelling was soft and compressible and non-tender. Overlying skin appeared normal. Intraoral examination revealed obliteration of vestibule in the region of 15, 16, 17. CBCT revealed presence of a cystic lesion associated with impacted 18 in the right maxillary sinus. The tooth was extracted along with the soft tissue component using Caldwell-Luc approach under general anaesthesia the sample was sent for histopathological examination which revealed the presence of dentigerous cyst associated with ectopic tooth. Postoperative period of the patient was uneventful [Figure 3].
Figure 3: Case number 3: (A) extraoral view, (B) extraoral view showing diffuse facial swelling, (C) intraoral view showing vestibular obliteration, (D, E) 3D-CECT revealed the presence of a lesion in the right maxillary sinus associated with an ectopic tooth, and (E) gross specimen picture

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  Discussion Top


Ectopic teeth in the maxillary sinus are a very uncommon occurrence. Only 35 occurrences have been described in English language medical literature since 1927, according to a recent review by Lamb et al.[8]

Ectopic tooth formation and eruption can originate from any aberrant tissue contact during odontogenesis.

The nasal septum, mandibular condyle, coronoid process, and palate are also possible ectopic locations. The ectopic tooth may be present in the maxillary sinus with or without symptoms in a very small percentage of cases.

Developmental abnormalities, such as cleft palate, trauma causing tooth displacement, maxillary infection, crowding, hereditary factors, and excessive bone density, are possible aetiologies.[9] However, the exact cause of ectopic teeth in the maxillary antrum is yet unknown. Dentigerous cysts, which are benign odontogenic cysts, have been linked to the formation of ectopic teeth in several studies.[10] The emergence of ectopic teeth in the maxillary sinus has also been linked to dental crowding in the buccal cavity.[11]

Recurrent or chronic sinusitis, purulent nasal discharge, and elevation of the orbital floor, recurrent haemoptysis, nasolacrimal duct obstruction, ostiomeatal complex obstruction,headaches, and facial numbness are all possible symptoms of ectopic tooth in maxillary sinus. A large dentigerous cyst may form around the tooth or root, resulting in an antro-cutaneous or antro-oral fistula.[1],[9],[10]

The most frequent type of developmental odontogenic cyst is a dentigerous cyst. After radicular cysts, these cysts are the second most frequent cystic lesion of the jaws. The mandible accounts for 70% of dentigerous cysts, while the maxilla accounts for 30%. Only 17 occurrences of dentigerous cysts associated with ectopic teeth within the maxillary sinus have been described since 1980.[2] On radiograph, it normally appears as a smooth unilocular lesion, but it can sometimes have a multilocular appearance. Ameloblastoma or carcinoma formation from the lining epithelium or remnants of odontogenic epithelium in the cyst wall are issues connected to this cyst, in addition to recurrence due to insufficient excision.[12]

Traditional treatments for sinus problems linked with ectopic teeth, such as antibiotics or antihistamines, may be ineffective.[10]

The surgical care of such teeth has been described in the literature as either a Caldwell-Luc surgery or an endoscopic technique.[8],[13],[14],[15] Surgical removal of the tooth and enucleation of the cyst is the preferred treatment for ectopic teeth associated with a cystic lesion in the maxillary sinus.[13] Enucleation and extraction of the cyst-associated impacted or unerupted tooth is the conventional therapy for a dentigerous cyst.[2] Although the classic Caldwell-Luc method allows a direct view into the maxillary sinus, it has a higher rate of morbidity than transnasal endoscopy.[13] If the tooth is tiny and close to the maxillary ostium, transnasal extradition may be attempted.[16] The surgeon should consider an endoscopic sinus approach rather than more traumatic procedures like the Caldwell-Luc method, according to Hasbini et al.[14] The benefits of extracting an intranasal tooth under endoscopic guidance include better illumination, excellent visualisation, and exact dissection.[17] To rule out any recurrence, postoperative follow-up with radiographic examination at regular intervals is required.[1]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ramanojam S, Halli R, Hebbale M, Bhardwaj S Ectopic tooth in maxillary sinus: Case series. Ann Maxillofac Surg 2013;3:89-92.  Back to cited text no. 1
    
2.
Buyukkurt MC, Omezli MM, Miloglu O Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: A report of 3 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:67-71.  Back to cited text no. 2
    
3.
Yaseen SM, Naik S, Uloopi KS Ectopic eruption - A review and case report. Contemp Clin Dent 2011;2:3-7.  Back to cited text no. 3
    
4.
Thesleff I, Nieminen P Tooth morphogenesis and cell differentiation. Curr Opin Cell Biol 1996;8:844-50.  Back to cited text no. 4
    
5.
Erkmen N, Olmez S, Onerci M Supernumerary tooth in the maxillary sinus: Case report. Aust Dent J 1998;43:385-6.  Back to cited text no. 5
    
6.
Ray B, Bandyopadhyay SN, Das D, Adhikary B A rare cause of nasolacrimal duct obstruction: Dentigerous cyst in the maxillary sinus. Indian J Ophthalmol 2009;57:465-7.  Back to cited text no. 6
    
7.
Elango S, Palaniappan SP Ectopic tooth in the roof of the maxillary sinus. Ear Nose Throat J 1991;70:365-6.  Back to cited text no. 7
    
8.
Lamb JF, Husein OF, Spiess AC Ectopic molar in the maxillary sinus precipitating a mucocele: A case report and literature review. Ear Nose Throat J 2009;88:E6-11.  Back to cited text no. 8
    
9.
Smith RA, Gordon NC, De Luchi SF Intranasal teeth. Report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol 1979;47:120-2.  Back to cited text no. 9
    
10.
Saleem T, Khalid U, Hameed A, Ghaffar S Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis. Head Face Med 2010;6:26.  Back to cited text no. 10
    
11.
Baykul T, Doğru H, Yasan H, Cina Aksoy M Clinical impact of ectopic teeth in the maxillary sinus. Auris Nasus Larynx 2006;33:277-81.  Back to cited text no. 11
    
12.
Golden AL, Foote J, Lally E, Beideman R, Tatoian J Dentigerous cyst of the maxillary sinus causing elevation of the orbital floor. Report of a case. Oral Surg Oral Med Oral Pathol 1981;52:133-6.  Back to cited text no. 12
    
13.
Di Pasquale P, Shermetaro C Endoscopic removal of a dentigerous cyst producing unilateral maxillary sinus opacification on computed tomography. Ear Nose Throat J 2006;85:747-8.  Back to cited text no. 13
    
14.
Hasbini AS, Hadi U, Ghafari J Endoscopic removal of an ectopic third molar obstructing the osteomeatal complex. Ear Nose Throat J 2001;80:667-70.  Back to cited text no. 14
    
15.
Srinivasa Prasad T, Sujatha G, Niazi TM, Rajesh P Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A rare entity. Indian J Dent Res 2007;18:141-3.  Back to cited text no. 15
    
16.
Goh YH Ectopic eruption of maxillary molar tooth–an unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80-1.  Back to cited text no. 16
    
17.
Kim DH, Kim JM, Chae SW, Hwang SJ, Lee SH, Lee HM Endoscopic removal of an intranasal ectopic tooth. Int J Pediatr Otorhinolaryngol 2003;67:79-81.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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