Ectopic third molar in the maxillary sinus. Case report

Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature

Background: The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic. Case presentation: A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla. Review Methods: An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up. Results: A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases. Conclusion: The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.

Endoscopic removal of ectopic sinonasal teeth: a systematic review

Introduction

Ectopic sinonasal teeth are uncommon. The classic approach to removal of such foreign bodies was the Caldwell-Luc. In recent years however, endoscopic approaches have become increasingly utilized. Despite this, there is a dearth of literature and consensus regarding the endoscopic removal of ectopic sinonasal teeth. As such, we conducted a systematic review on all cases of endoscopic removal of ectopic sinonasal teeth in the literature. With an understanding of the literature, clinical and technical decision making for patients with this pathology may be elucidated.

Methods

Systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases were conducted using PRISMA guidelines.

Results

Our search identified 100 articles. Final inclusion consisted of 23 studies with a total of 27 patient cases. The majority of the patients included were male (70.4%) with a mean age of 27.06 years. Patients presented with a multitude of symptoms, with nasal obstruction (48.14%), rhinorrhea (22.2%), facial pain (22.2%) and epistaxis (22.2%) being most common. Surgeons mostly reported using a 0° endoscope (22.2%) and performing a maxillary antrostomy/uncinectomy (37%) and simple extraction under general anesthetic (41%).

Conclusions

This systematic review analyzed important epidemiological, clinical and technical information regarding patients with endoscopic removal of sinonasal ectopic teeth. Further research is needed to promote implementation of such data into clinical practice.

An unusual presentation of an ectopic third molar in the condylar region

We describe the case of a 53-year-old patient who presented with an intermittent discharging sinus on his face which, following a number of investigations, was found to be secondary to an ectopic third molar in the condylar region. The ectopic tooth was surgically removed with complete resolution of the facial swelling. This case highlights the possibility of dental pathology presenting with completely unrelated signs and symptoms, and the importance of the clinician maintaining an open mind when it comes to the differential diagnosis of such a presentation.

Frontal mucocele caused by an ectopic maxillary tooth

OBJECTIVE

To present a previously unreported cause of frontal mucocele.

CASE REPORT

A patient presented with a frontal mucocele and maxillary sinusitis. Computed tomography revealed an ectopic maxillary tooth as the cause of her signs and symptoms. Removal of the tooth by a Caldwell-Luc procedure facilitated resolution of the mucocele. Conventional treatment of mucoceles by endoscopic sinus surgery, and other rhinological sequelae of ectopic teeth, are considered.

CONCLUSION

This is the first documented case of an ectopic tooth causing a frontal mucocele, and demonstrates how effectively the patient's symptoms resolved on removal of the tooth.

Clinical impact of ectopic teeth in the maxillary sinus

OBJECTIVE

To evaluate the clinical features, aetiologic factors, challenging properties (such as radio opacity in Water's view in a patient with no sinusitis), signs and symptoms of the ectopic teeth in the maxillary sinus.

STUDY DESIGN

Clinical symptoms and radiographic findings of 14 patients with ectopic teeth in the maxillary sinus were evaluated. Computed tomography (CT) and conventional radiographic images of maxillary sinus and clinical findings were compared with each other with regard to the final diagnosis.

RESULTS

Water's view is inadequate to diagnose ectopic tooth in the maxillary sinus in some cases. Panoramic radiographs may be preferred before CT to evaluate the ectopic tooth in the maxillary sinus as structure of a tooth can be clearly detected on panoramic radiographs. Crowding was the most common aetiologic factor among the 14 cases.

CONCLUSION AND SIGNIFICANCE

The patients with ectopic tooth in the maxillary sinus should be evaluated thoroughly by complete otorhinolaryngologic, intraoral examinations and proper diagnostic imaging procedures in order to avoid misdiagnosis of maxillary sinusitis. As the opacity of the maxillary sinus in Water's view due to ectopic tooth can be misinterpreted as maxillary sinusitis, patients who have sinusitis-like complaints and opacity of maxillary sinus in Water's view who are resistant to medical treatment should be evaluated with respect to the presence of ectopic tooth.

Extraoral inverted teeth eruption: a case report

A 14-year-old female presented with extraoral inverted eruption of left mandibular permanent molars 18 and 19 at the lower left inferior border of the mandible. Both the teeth started erupting 1 year after an extraoral surgical intervention for a discharging sinus 6 years ago. The subsequent eruption to the extraoral position of the permanent molars at the inferior border of mandible may be the result of the previous surgical procedure or pathology related to the abnormally positioned teeth. This case presents an infrequent complication affecting the adjacent permanent teeth.

Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: case report and literature review

Ectopic position of teeth is not rare. The presence of teeth have been reported in ovaries, testes, anterior mediastinum, and pre-sacral regions. In the maxillofacial region, teeth have been found in maxillary sinus, mandibular condyle, coronoid process, chin, nose, and even orbit. Approximately 50 cases of a tooth in the nasal cavity have been reported in literature. However, an intranasal tooth in cases of cleft lip and palate is comparatively rare. Intranasal teeth can cause problems such as nasal obstruction, chronic rhinorrhea and speech problems. Sometimes however, they are totally symptom-free. We present here an interesting case of an intranasal tooth in a four year-old-boy, who was operated on for cleft lip and alveolus at 6 months of age. The intranasal tooth did not cause any symptoms. The tooth was extracted under general anaesthesia when it was found to be very loosely attached to the nasal mucosa. The case is discussed in the light of relevant literature on intranasal teeth in cases of cleft lip and palate.

Supernumerary tooth in the maxillary sinus: case report

The ectopic development of teeth has been reported in many locations including the nasal cavity, maxillary sinus and the chin. Ectopic teeth may be permanent, deciduous or supernumerary. A case is presented in which a supernumerary tooth erupted into the maxillary sinus of an 11 year old boy.