CASE 10927 Published on 18.06.2013

Nasal tooth

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Foram Gala, Ankit Shah, Darshna Paunipagar, Bharat Gala

Lifescan Imaging Centre,
Mumbai, India;
Email:drforamgala@gmail.com
Patient

33 years, male

Categories
Area of Interest Anatomy, Ear / Nose / Throat ; Imaging Technique CT-High Resolution
Clinical History
A 33-year-old man had a history of recurrent sinusitis and nasal secretions on and off for a year. Clinical examination revealed a hard bump along the floor of the nasal cavity on the left side.
Imaging Findings
Limited CT scan of Paranasal sinuses (PNS) shows mucosal thickening in bilateral maxillary (left > right), ethmoid and frontal sinuses.
Deviated nasal septum to the left side with a small bony spur is also seen.
A well-defined densely calcified lesion having central lucency is seen partly embedded in the hard palate and protruding into the left nasal cavity. This has an imaging appearance like a tooth. The nasal mucosa covered the tooth.
This tooth was supernumerary. No supernumerary teeth were found on the right side. Otherwise teeth appeared normal.
Discussion
Teeth arising outside the confines of the oral cavity are called aberrant and such teeth can be deciduous, permanent or supernumerary. Nasal teeth are a rare form of aberrant teeth [1]. These are mostly supernumerary.

The cause of ectopic tooth is not well understood. It has been attributed to crowded dentition, persistent deciduous tooth or exceptionally dense bone. The other proposed pathogenic factors include a genetic predisposition, developmental disturbances such as cleft palate, rhinogenic or odontogenic infections and displacement as a result of trauma or cyst. Osteomyelitis of the maxilla has also been described as cause of nasal tooth.

Clinically it may be asymptomatic or present with unilateral or bilateral nasal obstruction, purulent nasal discharge, nasal ulceration, nasal deformity, foreign body sensation, headache, facial pain or epistaxis. [2]
In 25 % of reported cases of nasal teeth, rhinosinusitis was associated. [3] The nasal teeth may block the osteomeatal unit and result in development of sinusitis or polyposis.
On imaging, a nasal tooth appears similar to oral teeth. It is a hyperdense lesion with central lucency (pulp). There may be inflammatory tissue surrounding it suggestive of granulation tissue. This nasal tooth can rarely form nidus over which salts are deposited with resultant formation of rhinolith.
Differential diagnosis includes radio-opaque foreign body, rhinolith, inflammatory lesions like syphilis, and fungal infections with calcification.
CT scan helps in correctly differentiating these, as nasal teeth would have central hypodensity due to pulp. Fungal infections would usually involve the sinuses and secondarily involve the nasal cavity.
Tumours like haemangioma, osteoma (involves the bone and is extremely dense without central hypodensity), calcified polyps (usually these extend from sinuses), enchondroma (chondroid calcification is less dense than nasal teeth), dermoid (fat containing) and malignant tumours like chondrosarcoma and osteosarcoma (destructive lesions) should also be differentiated from nasal teeth.
Removal of nasal teeth alleviates the symptoms and complications like nasal ulceration, abscess formation, rhinolith, septal perforation, maxillary sinusitis [4].The time to remove the tooth is after the roots of the permanent teeth have completely formed to avoid injury during their development. Direct surgical removal or endonasal extraction under microscopic control (preferred) are the options to remove it. In case of asymptomatic teeth a close follow-up is advised in case the patient is unwilling for removal as these are associated with cystic complications. Rarely, carcinoma may occur [5]. Our patient refused to undergo surgical removal of the nasal tooth and is being symptomatically treated for sinusitis.
Differential Diagnosis List
Nasal tooth
Rhinolith
Foreign body
Final Diagnosis
Nasal tooth
Case information
URL: https://www.eurorad.org/case/10927
DOI: 10.1594/EURORAD/CASE.10927
ISSN: 1563-4086