|Year : 2015 | Volume
| Issue : 2 | Page : 75-76
Intranasal tooth as complication of cleft lip and palate in an adult patient: A case report and literature review
Yahia D Al-Ahmari1, Abdullah M Al-Hayan2
1 Senior Registrar, Mohayle General Hospital, Saudi Arabia
2 Senior ENT Resident, Otolaryngology, Head and Neck Surgery Department, Aseer Central Hospital, Saudi Arabia
|Date of Web Publication||2-Jan-2020|
MBBS Abdullah M Al-Hayan
Senior ENT Resident, Otolaryngology, Head and Neck Surgery Department, Aseer Central Hospital
MBBS Yahia D Al-Ahmari
Senior Registrar, Mohayle General Hospital
Source of Support: None, Conflict of Interest: None
We present a rare case of intranasal tooth in 22 years old male who was operated before 21 years for cleft lip.
This patient presented to otolaryngology outpatient clinic with complaint of long standing unilateral right nasal discharge. It is a rare complication of cleft lip and palate. There are only 7 cases reported in literatures and we believe this is the first case reported in adult patient.
Keywords: intranasal tooth, cleft lip, cleft palate
|How to cite this article:|
Al-Ahmari YD, Al-Hayan AM. Intranasal tooth as complication of cleft lip and palate in an adult patient: A case report and literature review. Saudi J Otorhinolaryngol Head Neck Surg 2015;17:75-6
|How to cite this URL:|
Al-Ahmari YD, Al-Hayan AM. Intranasal tooth as complication of cleft lip and palate in an adult patient: A case report and literature review. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2015 [cited 2022 Dec 9];17:75-6. Available from: https://www.sjohns.org/text.asp?2015/17/2/75/274662
| Introduction|| |
Nasally erupting tooth is a rare finding seen associated with cleft lip and palate. It may be diagnosed as a result of symptoms such as nasal obstruction, malodorous nasal discharge, pain on sneezing or blowing the nose. It may remain asymptomatic .
There are only 7 cases reported as intranasal tooth in patients with cleft lip and palate but all of them were from the pediatric age group, while in this case our patient is 22 years old and he was operated for unilateral cleft lip only without cleft palate .
| Case Report|| |
In January 2015, a Saudi male aged 22 years, presented to the outpatient clinic in Muhayil Asir General Hospital in Asir Region, Saudi Arabia, complaining of long standing malodorous right nasal discharge, attacks of epistaxis and pain. Patient had history of cleft lip which was repaired at age of one year. There was no history of facial trauma, nasal obstruction, change in smell sensation or headache. There was no history of foreign body or nasal surgery. Clinical examination showed unilateral purulent discharge in right nostril with white hard bony mass in the floor of anterior part of right nostril with hypertrophy and inflammatory changes in surrounding nasal mucosa [Figure 1]. Anterior and endoscopic rhinoscopy performed revealed normal septum, turbinates and nasopharynx without identification of other nasal masses.
CT scanning of paranasal sinuses, revealed hyperdense calcified bony mass in the floor of right nostril described as right lateral incisor tooth erupted intranasally [Figure 2],[Figure 3].
|Figure 2: coronal CT scan shows right intranasal hyperdense mass (right lateral incisor)|
Click here to view
The decision was made to extract the tooth under general anesthesia with orotracheal intubation. Longitudinal incision made through the floor of the nose and the tooth extracted smoothly without complication. Examination done of hard palate showed no fistulae formed [Figure 4]. Follow-up was maintained to monitor healing and complications.
| Discussion|| |
The presence of tooth in the nasal cavity is a rare phenomenon with obscure causes. In some cases there has been a history of facial trauma or osteomyelitis of the maxilla, causing displacement of one or more teeth into the nasal cavity . In this case report the intranasal tooth seen in previously operated patient for cleft lip only and presented at age of 22 years.
The occurrence of a cleft lip and palate is not a rare phenomena with a prevalence of 1 in 800 births . Most children are operated for cleft lip correction by 6 months and cleft palate by a year and half of age. Despite the corrective procedures these children suffer a number of dental and skeletal abnormalities such as anodontia, oligodontia, supernumerary teeth, delayed or premature eruption and maxillary arch hypoplasia . One of the rare complication of cleft lip and alveolus is nasally erupting tooth. After reviewing of all cases reported for same entity we found only 7 cases reported. Medeiros AS. et al  stated that the prevalence of intranasal teeth was found 0.40 % in unilateral cleft lip and palate, and 0.61 % in bilateral cleft lip and palate. It is seen to occur more in females than males .
The first case reported for intranasal tooth in cleft lip and palate patient was in 1934 by Endicott. Other authors also reported similar case ,. Kakade A. et al  presented case of a 4 year old boy with right nasally erupted canine operated previously for bilateral cleft lip and palate. Gupta YK. et al  reported a case in 4 years old child. Galben Gda S. et al  reported a case in a 9 years old girl. Yeung KH.  stated in his report that only 3 similar cases reported before all in children. The interested in our case that is the first case reported in adult patient another important issue is the previous history of cleft lip repair without cleft palate. The treatment in all cases remains the same - extraction of the tooth and follow up regarding healing process and development of complication may require plastic intervention for closure of fistulae. In case of a supernumerary tooth, there is no problem as a full complement of teeth would erupt unhampered,while in case of permanent tooth extraction further prosthetic rehabilitation would be required. In conclusion, intranasal tooth as complication of cleft lip and palate is a rare condition and it is important for otolaryngologist to put it in deferential diagnosis of nasal masses and causes of unilateral nasal discharge especially in cleft lip and palate patients.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]