Author(s)
Tiffany T. Pham, MS
Steven M. Chau, MD
Ifegwu O. Ibe, MD
Beverly Y. Wang, MD
Brian J.F. Wong, MD PhD
Affiliation(s)
University of California Irvine
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the diagnostic workup and management of intranasal supernumerary teeth. Objectives: Supernumerary teeth, which present in excess of normal teeth, are most commonly found in the upper incisor area. However, the occurrence of supernumerary teeth in the nasal cavity is rare and should be investigated with both imaging and pathology. We present a case report describing the diagnosis and endoscopic removal of an intranasal supernumerary tooth. Study Design: N/A. Methods: A 47 year old male patient presented with difficulty breathing through his right nasal cavity and intermittent epistaxis. He also noted a decreased sense of smell and discomfort of his right nasal airway and right upper teeth. Speculum exam and computed tomography scan demonstrated a 1 cm irregular calcification of the right nasal airway at the anterior aspect of the inferior turbinate, lateral to the maxillary crest. Results: Intraoperatively, the right nasal vault showed friable granulation tissue over a calcified mass. Endoscopic excision of the mass was performed with partial resection of the right inferior turbinate. Pathology reports this specimen as a tooth, consistent with supernumerary tooth. At 1 month followup patient reported resolution of right nasal obstruction and showed well healed nasal mucosa. Conclusions: This case highlights that the differential diagnosis for nasal obstruction is broad and that supernumerary teeth, though rarely, may be found in the nasal cavity. Pathology is imperative to rule out concerning differential diagnoses, such as a calcified inverted papilloma, osteoma, or malignant mass, which may require further surgical intervention. Endoscopic extraction affords many advantages such as optimal visualization, good illumination, more precise dissection, and improved postoperative course.