|Year : 2015 | Volume
| Issue : 1 | Page : 57-59
Tooth in maxillary sinus
A Jegadesh Shankar1, G Vijay Prabu2
1 Department of Dentistry, Chennai Medical College Hospital and Research Center, Irungalur, Mannachanallur Taluk, Tiruchirappalli, India
2 Consultant Oral Surgeon, Tiruppur, Tamil Nadu, India
|Date of Web Publication||19-Jan-2015|
A Jegadesh Shankar
Department of Dentistry, Chennai Medical College Hospital and Research Center, Irungalur, Mannachanallur Taluk, Tiruchirappalli - 621 105, Tamil Nadu
The pathogenesis of ectopic teeth is unknown, but it could be due to tissue interactions during tooth development. The causes can be multi-factorial. Ectopic teeth may be permanent, deciduous, or supernumerary. Maxillary canine and mandibular third molar are the most frequently involved tooth. Ectopic eruption of teeth other than the oral cavity is rare, but various authors have reported ectopic teeth in various facial region. Tooth in the maxillary antrum may cause local sinonasal symptoms. Water's view, panoramic radiography, and plain skull radiography are advocated for maxillary sinus pathology. Routine computerized tomography imaging is debatable. The standard treatment for an ectopic tooth in the maxillary sinus is a surgical removal through Caldwell-Luc procedure and recently functional endoscopic sinus surgery is gaining popularity. We report a case of ectopic eruption of maxillary right first molar in the maxillary sinus with the complaint of foul smelling discharge from the nose and surgically removed by Caldwell-Luc procedure.
Keywords: Ectopic tooth, impacted tooth, maxillary sinus
|How to cite this article:|
Shankar A J, Prabu G V. Tooth in maxillary sinus. SRM J Res Dent Sci 2015;6:57-9
| Introduction|| |
The pathogenesis of ectopic teeth is still not clear. Tissue interactions during tooth development could be the cause and it can be due to developmental disturbances, trauma, iatrogenic, pathology,  and genetic factors. ,, Ectopic teeth may be permanent, deciduous, or supernumerary.  Maxillary canine and mandibular third molar are the most frequently involved tooth.  Tooth in the maxillary antrum may cause recurrent or chronic sinusitis,  Facial pain, epistaxis, purulent rhinorrhea, swelling, and epiphora related nasolacrimal duct obstruction.  On the other hand, there are case reports with no symptoms and found incidentally during routine clinical or radiological investigation. Various radiographs have been advocated to rule out maxillary sinus pathology.  Computerized tomography (CT) imaging may be helpful for large lesions those involving the maxilla, nasal cavity, orbital, or pterygomaxillary space.  The management for an ectopic tooth is surgical removal. We present a case report of a patient who had tooth in the maxillary sinus and successfully managed.
| Case report|| |
A 20-year-old male patient reported to our hospital with the chief complaint of foul smelling discharge from the nose for 3 months. On local examination, we found his upper right first molar was missing which raised the doubt of impacted tooth, so we decided to confirm the diagnosis with orthopantomogram (OPG) [Figure 1]. OPG demonstrated that the tooth was displaced into the maxillary sinus. Subsequently, CT scan [Figure 2] and [Figure 3] was taken to get a clearer picture of the tooth position in the maxillary sinus. After the routine blood investigations, the impacted tooth was removed through Caldwell procedure under general anesthesia [Figure 4] and [Figure 5]. All diseased sinus mucosa was removed and wound closed with 3-0 vicryl. Patient was stable and relieved from his symptoms at the time of discharge. Regular followup visits have been made, and the patient is doing well still.
| Discussion|| |
The process of tooth development is the corollary of complex interactions between the oral epithelium and the underlying mesenchymal tissue.  If abnormal tissue interactions disrupt the process it results in ectopic tooth development and eruption.  Ectopic teeth are commonly observed in the second or third decade of life.  The incidence is higher in men than in women.  Ectopic eruption of teeth other than the oral cavity is rare, but various authors have reported ectopic teeth in the nasal septum, mandibular condyle, coronoid process, maxillary sinus, and orbital cavity. ,,, There are quite a few case reports of tooth in the maxillary sinus. Smith et al., Pracy et al., and Spencer and Couldery reported cases of intranasal teeth.  Subramaniam et al. reported a case in which a patient with missing upper lateral incisor was found in the nasal cavity.  Gadalla  presented a case in which a patient complained of two teeth that had erupted through her chin. Elango and Palaniappan described an upper third molar in the roof of the maxillary sinus.  Di Felice and Lombardi reported ectopic third molar in the maxillary sinus. 
A cyst may involve the impacted tooth. Hasbini et al., Kaya et al., and Kusukawa et al. reported that Dentigerous cysts are the most frequent type of developmental odontogenic cysts,  however periapical cyst  and odontogenic keratocyst  are also reported. Dentigerous cysts usually involve permanent teeth but Kusukawa et al.  and Most and Roy  reported with a deciduous tooth and supernumerary tooth respectively. On rare occasions, squamous cell carcinoma, mucoepidermoid carcinoma or ameloblastoma can develop in dentigerous cysts.  Dentigerous cysts are treated either by enucleation or marsupialization. The prognosis is excellent and recurrence is rarely observed after a complete removal. 
Water's view, panoramic radiography, and plain skull radiography are advocated for maxillary sinus pathology, which are simple and relatively inexpensive methods. There are limitations with radiographs. In extensive cases radiography alone may not be sufficient to show the full extent of the lesions, an advanced imaging may be needed. CT imaging may be needed for large lesions involving the maxilla, nasal cavity, orbital or pterygomaxillary space.  Bodner et al.  stated that CT is a highly valuable tool for the imaging and management of teeth in the maxillary sinus. CT provides more details about the size and extent of the lesion as well as aids in planning for surgery. In our case, CT images allowed better depiction of the involved structures.
A complete clinical and radiographic examination is needed to plan the surgical approach. The treatment of ectopic maxillary tooth is surgical removal through Caldwell-Luc procedure. Caldwell-Luc procedure is commonly used for the management of pathologies involving the maxillary sinus. The development of endoscopic sinus surgery has changed the scenario, but still conditions where the wide anterior opening provided by the Caldwell-Luc procedure might prove to be beneficial. ,, It is also mandatory to completely remove all diseased antral tissues and thoroughly assess all resected soft tissue histologically. 
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]