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Case Reports
. 2021 Sep 21;14(9):e245103.
doi: 10.1136/bcr-2021-245103.

Supernumerary tooth in nasopalatine canal: a rare cause of septal cartilage collapse

Rasads Misirovs  1 , Avinash Kumar Kanodia  2 , Christopher McDonald  3 , Richard Green  1
Affiliations
Case Reports

Supernumerary tooth in nasopalatine canal: a rare cause of septal cartilage collapse

Rasads Misirovs et al. BMJ Case Rep. .

Abstract

Mesiodens is the most common type of supernumerary tooth, located between the maxillary central incisors in close relation to the nasopalatine canal. A 20-year-old man presented with right-sided nasal blockage, nasal discharge and collapsed nose without history of trauma. Imaging revealed a calcified mass in the inferior meatus extending into dilated nasopalatine canal. Endoscopic removal of the mass revealed tuberculate appearance of an incompletely developed tooth, consistent with mesiodens. Based on the history of septal cartilage collapse with right-sided mucopurulent discharge, endoscopic findings of the right inferior turbinate being adherent to the septal cartilage and the underlying mesiodens, we believe that the patient developed a septal abscess secondary to infection in nasal mucosa surrounding the mesiodens causing collapse of septal cartilage. While a tooth or tooth-like mass causing nasal passage air-flow obstruction is uncommon, we believe that this is the first reported case of mesiodens presenting with septal cartilage collapse.

Keywords: ear; nose and throat/otolaryngology; radiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Non-contrast CT. Coronal (A), sagittal (B) and axial (C) reconstructions. Thick white arrow shows the mesiodens. Thin white arrow shows the dilated nasopalatine canal. (D) Coronal image shows bone defect in nasal septum (white arrow). Black arrow in (D) and (E) shows soft tissue thickening around the mesiodens. Thick white arrow in (E) shows flattened nose. Modified sagittal image (F) shows tuberculate shape with different tubercles/cusps.
Figure 2
Figure 2
MRI. (A) T1 coronal and (B) Short Tau inversion recovery (STIR) coronal images. White arrow shows the mesiodens with low T1 signal. (C) T1 axial and (D) STIR axial images. White arrow shows the collapsed nasal cartilage.
Figure 3
Figure 3
Endoscopic images. (A) Normal endoscopic findings of left nasal passage. (B) Right nasal passage nasal mass with overlying inflamed mucosa. (C) Easily separable overlying mucosa from nasal mass in right nasal passage. (D) The mesiodens with tubercles.
Figure 4
Figure 4
Histopathology image. (A) Mucosa (stratified squamous epithelium and fibroconnective tissue), (B) tubular dentine, (C) pulp chamber.
See this image and copyright information in PMC

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