An intranasal ectopic tooth associated with rhinolith formation was identified in a patient with persistent unilateral nasal discharge and intermittent epistaxis, with symptoms resolving following endoscopic removal.
Researchers described a 45-year-old male patient who presented with a 6-month history of continuous, greenish to mucoid, foul-smelling right-sided nasal discharge and intermittent mild epistaxis. He had no history of facial or dental trauma, nasal surgery, tooth extraction, congenital dental anomalies, systemic illness, or radiation exposure. Anterior rhinoscopy and nasal endoscopy revealed a hard, irregular, white mass arising from the floor of the right nasal cavity and partially surrounded by calcified material.
Noncontrast computed tomography (CT) of the paranasal sinuses showed a well-defined, hyperdense, tooth-like structure arising from the hard palate and projecting into the floor of the right nasal cavity. The lesion had attenuation similar to dental enamel and dentin and contained a central low-density pulp cavity. Surrounding curvilinear calcifications were consistent with rhinolith formation.
CT showed no adjacent bony destruction, cortical erosion, aggressive periosteal reaction, or extension into neighboring structures. There was also no nasal septal deviation or sinus opacification. The tooth-like morphology and central pulp cavity helped distinguish the lesion from other calcified intranasal abnormalities. Rhinoliths generally lack the organized anatomy of enamel, dentin, and a pulp cavity, whereas calcified neoplasms may demonstrate different imaging characteristics, including homogeneous osseous appearance or destructive growth.
The patient underwent endoscopic transnasal removal of the rhinolith and ectopic tooth, with an uneventful postoperative course and no reported complications. At follow-up, the nasal cavity appeared healthy, and the patient remained symptom-free, with complete resolution of the nasal obstruction and discharge.
Intranasal ectopic teeth are uncommon and can be asymptomatic or present with nonspecific sinonasal symptoms. A systematic review cited in the report found nasal obstruction in 48% of cases and rhinorrhea, facial pain, and epistaxis in 22% each. CT provided detailed information on the location, morphology, and relationship of an ectopic tooth to surrounding structures, while nasal endoscopy permitted direct visualization and facilitated surgical management.
Potential contributors to the ectopic tooth included obstruction of tooth eruption, inadequate space in the dental arch, trauma, developmental anomalies, cysts, and genetic predisposition. However, no definitive causative factor was identified in this patient. The researchers noted that asymptomatic ectopic intranasal teeth may be managed conservatively with regular observation and follow-up.
“Recognition of these imaging findings is important because calcified intranasal lesions are uncommon and may mimic a variety of entities,” wrote lead study author Bijay Kunwar, MBBS, of Maharajgunj Medical Campus at the Tribhuvan University Institute of Medicine in Nepal, and colleagues.
The study authors reported no conflicts of interest.
Source: Radiology Case Reports