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Table of Contents
CLINICAL CASE
Year : 2015  |  Volume : 17  |  Issue : 2  |  Page : 75-76

Intranasal tooth as complication of cleft lip and palate in an adult patient: A case report and literature review


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 Publication2-Jan-2020

Correspondence Address:
MBBS Abdullah M Al-Hayan
Senior ENT Resident, Otolaryngology, Head and Neck Surgery Department, Aseer Central Hospital
Saudi Arabia
MBBS Yahia D Al-Ahmari
Senior Registrar, Mohayle General Hospital
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.274662

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  Abstract 


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 Top


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 [1].

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 Top


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.
Figure 1: intranasally erupted tooth seen clinically

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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)

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Figure 3: axial CT scan at level of hard palate

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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.
Figure 4: Intranasal right lateral incisor after extraction.

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  Discussion Top


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 [2]. 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 [3]. 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 [4]. 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 [5] 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 [6],[4]. Kakade A. et al [1] 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 [7] reported a case in 4 years old child. Galben Gda S. et al [8] reported a case in a 9 years old girl. Yeung KH. [9] 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 Top

1.
Kakade A1, Gandhy MM, Damle SG. Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient. J Indian Soc Pedod Prev Dent. 2006 Mar; 24(1):40-1.  Back to cited text no. 1
    
2.
Nigel M. King1, Albert M.P Lee . An intranasal tooth in a patient with a cleft lip and palate: report of case. JADA,Vol.114, April 1987 .  Back to cited text no. 2
    
3.
Damle SG. Textbook of pediatric dentistry. 2nd edn. Arya Med Publishing House: Delhi, India  Back to cited text no. 3
    
4.
Harris EF1, Hullings JG. Delayed dental development in children with isolated cleft lip and palate. Arch Oral Biol. 1990; 35 (6): 469-73.  Back to cited text no. 4
    
5.
Medeiros AS1, Gomide MR, Costa B, Carrara CF, das Neves LT. Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate. Cleft Palate Craniofac J. 2000 May; 37(3): 271-3.  Back to cited text no. 5
    
6.
King NM, Lee AM. An intranasal tooth in a patient with a cleft lip and palate: report of case. J Am Dent Assoc. 1987 Apr; 114( 4): 475-8.  Back to cited text no. 6
    
7.
Gupta YK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: case report and literature review. Int J Paediatr Dent. 2001 May; 11 (3): 221-4. Review .  Back to cited text no. 7
    
8.
Dalben Gda S, Vargas VP, Barbosa BA, Gomide MR, Consolaro A. Intranasal tooth and associated rhinolith in a patient with cleft lip and palate. Ear Nose Throat J. 2013 Mar; 92(3): E10-4.  Back to cited text no. 8
    
9.
Yeung KH, Lee KH. Intranasal tooth in a patient with a cleft lip and alveolus. Cleft Palate Craniofac J. 1996 Mar; 33 (2): 157-9. Review.s  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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