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A Case Report of Supernumerary Tooth and Review of Literature
Case Report
Aliris'NaslIs'Larynx (Tokyo) 18,183-187 (1991)
A CASE REPORT OF SUPERNUMERARY TOOTH AND REVIEW OF LITERATURE Naoki
OHASHI,
M.D. and Masato
HORI,
M.D.*
Department of Otolaryngology, FacilIty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan * Takanomia ENT Clinic, Takaoka, Japan
A boy visited an ear-nose and throat clinic for serous rhinorrhea and a tumor-like mass in the nasal cavity. X-ray and computered tomographies showed a bone-like mass with a slightly radiolucent center which seemed to stem from the nasal septum. A supernumerary tooth in the nasal cavity was extirpated under local anesthesia. In some reports, complications of supernumerary tooth were severe and involved areas other than the nose (cleft lip and/or palate, bilateral aniridia and ectopia lentis, familial adenomatous polyposis coli, ventricular septal defect or patent ductus arteriosus). A case had a risk of inducing severe intracranial complication. Therefore we must not overlook a supernumerary tooth. We encountered a rare case of a supernumerary tooth in the nasal cavity of a 9-year-old boy. The tooth was easily removed by surgery under local anesthesia. There were no complications other than serous rhinorrhea: a review shows reports of cases with severe complications. REPORT OF A CASE
A 9-year-old boy visited an ear-nose and throat (ENT) clinic for serous rhinorrhea. Anterior rhinoscopy disclosed a tumor-like mass between the inferior turbinate and the nasal septum in the left nasal cavity. The patient was referred to the outpatient department of Toyama Medical and Pharmaceutical University for further examination. Anterior rhinoscopy (Fig. I) showed a white mass in the left nasal cavity. X-ray tomography (Fig. 2) showed a bone-like mass with a slightly radiolucent center. Computered tomography (CT, Fig. 3) showed a mass which seemed to stem from the nasal septum. Extirpated under local anesthesia, a tooth, covered partly by the mucosal membrane, was about 15 X 3 X Received for publication
June 22, 1990 183
N. OHASHI and M. HORI
184
Fig. 1. The anterior rhinoscopy shows a white mass coated with the serous rhinorrhea in the left nasal cavity.
Fig. 3.
Fig. 2. A tomography of the paranasal sinuses demonstrates the radiolucent center of the tooth-like mass.
The mass seems to stem from the nasal septum by a CT.
3 mm (Fig. 4). DISCUSSION
Supernumerary teeth are relatively common in the field of dentistry. PARRY and IYER (1961) report that 2.5 % of 2,000 Indian people had supernumerary teeth, usually found by intra-oral radiographs. Ninety percent of the such teeth are found in the maxilla, 10 %in the mandible (PARRY and IYER, 1961 ; HIRANANDANI and MELGIRI, 1968). In 8 out of 13 reports on supernumerary teeth, complica-
185
SUPERNUMERARY TOOTH IN THE NASAL CAVITY
Fig. 4.
An extirpated tooth is about 15 x 3 x 3 mm. Table I.
Summary of reports.
-- - --------------------------~---
Reporter
Site of ST
Nasal complications
---~--
Other complications
Dahllof
not mentioned
cleft lip and/or palate
Zamzam
palate
mental retardation, aniridia, ectopia lentis
Sondergaard not mentioned Suzuki
middle nasal turbinate
Sjoberg
superior orbital fissure
Hiranandani floor of nose -
- - - - - - - -------
-
familial adenomatous polyposis coli nasal obstruction
patent ductus arteriosus, cleft palate, VSD threat of intracranial complication
epistaxis, purulent rhinorrhea
- - - - - - - - - -- - -- -- - - -- - - - - - - - - - - - - -
Kohli
nasal cavity (septum)
septal abscess, nasal obstruction, epistaxis, rhinorrhea
Nishikawa
floor of nose
nasal obstruction
Yamazaki
maxillary sinus
acute neonatal maxillitis
Silberzahn
ethmoid
cheek pain
Uchida
floor of nose
epistaxis
Sofat
floor of nose
nasal pain
Rao
floor of nose
serous rhinorrhea, anosmia
ST, supernumerary tooth; VSD, ventricular septal defect.
N. OHASHI and M. HORI
186
tions were relatively mild and, related only to the nose (nasal cavity, nasal septum, and/or paranasal sinus). The complications were epistaxis, nasal obstruction, rhinorrhea (serous and/or purulent), septal abscess, nasal pain, anosmia, cheek pain, and acute neonatal maxillitis (RAo, 1953; HIRANANDANI and MELGIRI, 1968; KOHLI and VERMA, 1970; SOFAT and KHURANA 1982; YAMAZAKI and FUJIMOTO, 1982; SJOBERG and LORINC 1984; NISHIKAWA and NISHIKAWA, 1985; SILBERZAHN, 1988; UCHIDA, 1988). However in 4 of the 13 reports, complications were severe and involved areas other than the nose (SONDERGAARD, BULow, JARVINEN, WOLF, WITT, and TOTENS, 1987; SUZUKI, 1988; ZAMZAM, SCHERIFF, and PHILLIPS, 1988; DAHLLOF, USSISOOJOANDI, IDEBERG, and MODEER, 1989). 1: Supernumerary teeth are reported at significant frequency in children with cleft lip and/or palate. DAHLLOF et al. (1989) made a study of oral health in 49 children, 5 or 6 years old, with cleft lip and/or palate and 49 healthy controls matched for sex and age. They found a significantly higher incidence of supernumerary teeth in the children with cleft lip and/or palate. 2: A supernumerary tooth can appear as one of the symptoms of a hereditary disorder. ZAMZAM et al. (1988) report a 13-year-old boy with bilateral aniridia and ectopia lentis, with two supernumerary teeth on the palate. The cause was thought to be a single autosomal recessive gene defect, because his parents were second cousins. 3: A supernumerary tooth can be one of the manifestations of familial adenomatous polyposis coli (FPC). SONDERGAARD et al. (1987) report 11 (11 %) among 97 cases with FPC had supernumerary teeth, concluding that dental abnormalities should be included in the list of extracolonic manifestations that may occur in any FPC patient. 4: Supernumerary teeth are associated with cleft palate, ventricular septal defect and patent ductus arteriosus (SUZUKI, 1988). Additionally, there is one report on a very abnormally located supernumerary tooth: the tooth was located intracranially (between the orbit and the brain) and posed a risk of inducing severe intracranial complication (SJOBERG and LORINC, 1984). Therefore we must not overlook a supernumerary tooth as a positive cause of severe complications. The etiology of supernumerary teeth may be explained by disturbances in migration, proliferation, and differentiation of neural crest cells or interactions between the epitheliums and mesenchymal cells during the initiation of odontogenesis (RANTA, 1988). Reports of DAHLLOF et al. (1989), ZAMZAM et al. (1988), SUZUKI (1988), and SONDERGAARD et al. (1987) on supernumerary teeth having severe complications in areas other than the nose support the above hypothetical etiology of supernumerary teeth. REFERENCES G., USSISOO-JOANDI, R., IDEBERG, M., and MODEER, T.: Caries, gingivitis, and dental abnormalities in preschool children with cleft lip and/or palate. Cleft Palate J. 26: 233-237,
DAHLLOF,
1989
SUPERNUMERARY TOOTH IN THE NASAL CAVITY
187
HIRANANDANI, L. H., and MELGIRI, R. D.: Supernumerary tooth in the floor of nose. J. LarYlIgol. Otol. 82: 845-848, 1968. KOHLI, G. S., and VERMA, P. L.: Ectopic supernumerary tooth in nasal cavity. J. LarYlIgol. Otol. 84: 537-538, 1970. NISHIKAWA, K., and NISHIKAWA, M.: A case of abnormal dental eruption in the nasal cavity. Pract. Otol. (Kyoto) 78: 2771-2773, 1985. PARRY, R. R., and IYER, V. S.: Supernumerary teeth amongst orthodontic patients in India. Br. Delltal.T. 11: 257-258, 1961. RANTA, R.: Numeric anomalies of teeth in concomitant hypodontia and hyperdontia. J. emllio/ac. Genet. Del'. Boil. 8: 245-251,1988. RAO, A. B. N.: Aberrant canine tooth in the nose. J. Laryngol. Otol. 67: 370-371, 1953. SILBERZAHN, J.: Supernumerary molar in the right ethmoid sinus. Laryngol. Rhil/ol. Otol. 67: 545-546, 1988. SOFAT, J. R., and KHURANA, A. S.: Ectopic supernumerary tooth in nasal cavity. J. Indial/ Del/t. Assoc. 54: 223, 1982. SONDERGAARD, J. 0., BULOW, S., JARVINEN, H., WOLF, J., WITT, 1. N., and TOTENS, G.: Dental anomalies in familial adenomatous polyposis coli. Acta Odontol. Scand. 45: 61-63, 1987. SJOBERG, S., and LORINC, P.: Intracranial supernumerary tooth. Case report. Radiologe 24: 561-562, 1984. SUZUKI, M.: Supernumerary teeth in the middle nasal turbinate. OtolarYl/gol. Head Neck SlIrg. 60: 345- 348, 1988. UCHIDA, T.: A supernumerary tooth in the floor of the nose. OlolarYl/gol. Head Neck SlIrg. 60: 151-155, 1988. YAMAZAKI, Y., and FUJIMOTO, M.: An inverted tooth in the nasal cavity. OtolarYlIgol. Fuklloka 28: 589-592, 1982. ZAMZAM, A. M., SCHERIFF, S. M. M., and PHILLIPS, C. I.: Aniridia, ectopia lentis, abnormal upper incisors and mental retardation-An autosomal recessive syndrome-. lpl/. J. Ophthalmol. 32: 375-378, 1988.
Request reprints to:
Dr. N. Ohashi, Department of Otolaryngology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-01, Japan
Aliris'NaslIs'Larynx (Tokyo) 18,183-187 (1991)
A CASE REPORT OF SUPERNUMERARY TOOTH AND REVIEW OF LITERATURE Naoki
OHASHI,
M.D. and Masato
HORI,
M.D.*
Department of Otolaryngology, FacilIty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan * Takanomia ENT Clinic, Takaoka, Japan
A boy visited an ear-nose and throat clinic for serous rhinorrhea and a tumor-like mass in the nasal cavity. X-ray and computered tomographies showed a bone-like mass with a slightly radiolucent center which seemed to stem from the nasal septum. A supernumerary tooth in the nasal cavity was extirpated under local anesthesia. In some reports, complications of supernumerary tooth were severe and involved areas other than the nose (cleft lip and/or palate, bilateral aniridia and ectopia lentis, familial adenomatous polyposis coli, ventricular septal defect or patent ductus arteriosus). A case had a risk of inducing severe intracranial complication. Therefore we must not overlook a supernumerary tooth. We encountered a rare case of a supernumerary tooth in the nasal cavity of a 9-year-old boy. The tooth was easily removed by surgery under local anesthesia. There were no complications other than serous rhinorrhea: a review shows reports of cases with severe complications. REPORT OF A CASE
A 9-year-old boy visited an ear-nose and throat (ENT) clinic for serous rhinorrhea. Anterior rhinoscopy disclosed a tumor-like mass between the inferior turbinate and the nasal septum in the left nasal cavity. The patient was referred to the outpatient department of Toyama Medical and Pharmaceutical University for further examination. Anterior rhinoscopy (Fig. I) showed a white mass in the left nasal cavity. X-ray tomography (Fig. 2) showed a bone-like mass with a slightly radiolucent center. Computered tomography (CT, Fig. 3) showed a mass which seemed to stem from the nasal septum. Extirpated under local anesthesia, a tooth, covered partly by the mucosal membrane, was about 15 X 3 X Received for publication
June 22, 1990 183
N. OHASHI and M. HORI
184
Fig. 1. The anterior rhinoscopy shows a white mass coated with the serous rhinorrhea in the left nasal cavity.
Fig. 3.
Fig. 2. A tomography of the paranasal sinuses demonstrates the radiolucent center of the tooth-like mass.
The mass seems to stem from the nasal septum by a CT.
3 mm (Fig. 4). DISCUSSION
Supernumerary teeth are relatively common in the field of dentistry. PARRY and IYER (1961) report that 2.5 % of 2,000 Indian people had supernumerary teeth, usually found by intra-oral radiographs. Ninety percent of the such teeth are found in the maxilla, 10 %in the mandible (PARRY and IYER, 1961 ; HIRANANDANI and MELGIRI, 1968). In 8 out of 13 reports on supernumerary teeth, complica-
185
SUPERNUMERARY TOOTH IN THE NASAL CAVITY
Fig. 4.
An extirpated tooth is about 15 x 3 x 3 mm. Table I.
Summary of reports.
-- - --------------------------~---
Reporter
Site of ST
Nasal complications
---~--
Other complications
Dahllof
not mentioned
cleft lip and/or palate
Zamzam
palate
mental retardation, aniridia, ectopia lentis
Sondergaard not mentioned Suzuki
middle nasal turbinate
Sjoberg
superior orbital fissure
Hiranandani floor of nose -
- - - - - - - -------
-
familial adenomatous polyposis coli nasal obstruction
patent ductus arteriosus, cleft palate, VSD threat of intracranial complication
epistaxis, purulent rhinorrhea
- - - - - - - - - -- - -- -- - - -- - - - - - - - - - - - - -
Kohli
nasal cavity (septum)
septal abscess, nasal obstruction, epistaxis, rhinorrhea
Nishikawa
floor of nose
nasal obstruction
Yamazaki
maxillary sinus
acute neonatal maxillitis
Silberzahn
ethmoid
cheek pain
Uchida
floor of nose
epistaxis
Sofat
floor of nose
nasal pain
Rao
floor of nose
serous rhinorrhea, anosmia
ST, supernumerary tooth; VSD, ventricular septal defect.
N. OHASHI and M. HORI
186
tions were relatively mild and, related only to the nose (nasal cavity, nasal septum, and/or paranasal sinus). The complications were epistaxis, nasal obstruction, rhinorrhea (serous and/or purulent), septal abscess, nasal pain, anosmia, cheek pain, and acute neonatal maxillitis (RAo, 1953; HIRANANDANI and MELGIRI, 1968; KOHLI and VERMA, 1970; SOFAT and KHURANA 1982; YAMAZAKI and FUJIMOTO, 1982; SJOBERG and LORINC 1984; NISHIKAWA and NISHIKAWA, 1985; SILBERZAHN, 1988; UCHIDA, 1988). However in 4 of the 13 reports, complications were severe and involved areas other than the nose (SONDERGAARD, BULow, JARVINEN, WOLF, WITT, and TOTENS, 1987; SUZUKI, 1988; ZAMZAM, SCHERIFF, and PHILLIPS, 1988; DAHLLOF, USSISOOJOANDI, IDEBERG, and MODEER, 1989). 1: Supernumerary teeth are reported at significant frequency in children with cleft lip and/or palate. DAHLLOF et al. (1989) made a study of oral health in 49 children, 5 or 6 years old, with cleft lip and/or palate and 49 healthy controls matched for sex and age. They found a significantly higher incidence of supernumerary teeth in the children with cleft lip and/or palate. 2: A supernumerary tooth can appear as one of the symptoms of a hereditary disorder. ZAMZAM et al. (1988) report a 13-year-old boy with bilateral aniridia and ectopia lentis, with two supernumerary teeth on the palate. The cause was thought to be a single autosomal recessive gene defect, because his parents were second cousins. 3: A supernumerary tooth can be one of the manifestations of familial adenomatous polyposis coli (FPC). SONDERGAARD et al. (1987) report 11 (11 %) among 97 cases with FPC had supernumerary teeth, concluding that dental abnormalities should be included in the list of extracolonic manifestations that may occur in any FPC patient. 4: Supernumerary teeth are associated with cleft palate, ventricular septal defect and patent ductus arteriosus (SUZUKI, 1988). Additionally, there is one report on a very abnormally located supernumerary tooth: the tooth was located intracranially (between the orbit and the brain) and posed a risk of inducing severe intracranial complication (SJOBERG and LORINC, 1984). Therefore we must not overlook a supernumerary tooth as a positive cause of severe complications. The etiology of supernumerary teeth may be explained by disturbances in migration, proliferation, and differentiation of neural crest cells or interactions between the epitheliums and mesenchymal cells during the initiation of odontogenesis (RANTA, 1988). Reports of DAHLLOF et al. (1989), ZAMZAM et al. (1988), SUZUKI (1988), and SONDERGAARD et al. (1987) on supernumerary teeth having severe complications in areas other than the nose support the above hypothetical etiology of supernumerary teeth. REFERENCES G., USSISOO-JOANDI, R., IDEBERG, M., and MODEER, T.: Caries, gingivitis, and dental abnormalities in preschool children with cleft lip and/or palate. Cleft Palate J. 26: 233-237,
DAHLLOF,
1989
SUPERNUMERARY TOOTH IN THE NASAL CAVITY
187
HIRANANDANI, L. H., and MELGIRI, R. D.: Supernumerary tooth in the floor of nose. J. LarYlIgol. Otol. 82: 845-848, 1968. KOHLI, G. S., and VERMA, P. L.: Ectopic supernumerary tooth in nasal cavity. J. LarYlIgol. Otol. 84: 537-538, 1970. NISHIKAWA, K., and NISHIKAWA, M.: A case of abnormal dental eruption in the nasal cavity. Pract. Otol. (Kyoto) 78: 2771-2773, 1985. PARRY, R. R., and IYER, V. S.: Supernumerary teeth amongst orthodontic patients in India. Br. Delltal.T. 11: 257-258, 1961. RANTA, R.: Numeric anomalies of teeth in concomitant hypodontia and hyperdontia. J. emllio/ac. Genet. Del'. Boil. 8: 245-251,1988. RAO, A. B. N.: Aberrant canine tooth in the nose. J. Laryngol. Otol. 67: 370-371, 1953. SILBERZAHN, J.: Supernumerary molar in the right ethmoid sinus. Laryngol. Rhil/ol. Otol. 67: 545-546, 1988. SOFAT, J. R., and KHURANA, A. S.: Ectopic supernumerary tooth in nasal cavity. J. Indial/ Del/t. Assoc. 54: 223, 1982. SONDERGAARD, J. 0., BULOW, S., JARVINEN, H., WOLF, J., WITT, 1. N., and TOTENS, G.: Dental anomalies in familial adenomatous polyposis coli. Acta Odontol. Scand. 45: 61-63, 1987. SJOBERG, S., and LORINC, P.: Intracranial supernumerary tooth. Case report. Radiologe 24: 561-562, 1984. SUZUKI, M.: Supernumerary teeth in the middle nasal turbinate. OtolarYl/gol. Head Neck SlIrg. 60: 345- 348, 1988. UCHIDA, T.: A supernumerary tooth in the floor of the nose. OlolarYl/gol. Head Neck SlIrg. 60: 151-155, 1988. YAMAZAKI, Y., and FUJIMOTO, M.: An inverted tooth in the nasal cavity. OtolarYlIgol. Fuklloka 28: 589-592, 1982. ZAMZAM, A. M., SCHERIFF, S. M. M., and PHILLIPS, C. I.: Aniridia, ectopia lentis, abnormal upper incisors and mental retardation-An autosomal recessive syndrome-. lpl/. J. Ophthalmol. 32: 375-378, 1988.
Request reprints to:
Dr. N. Ohashi, Department of Otolaryngology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-01, Japan