Ectopic Tooth in the Roof of the Left Maxillary Sinus

Abstract

The presence of sinonasal ectopic teeth is a rare entity that is usually asymptomatic. In some cases, the presence of foreign bodies in the maxillary sinus, such as ectopic teeth, can lead to chronic maxillary sinusitis. We report a case of chronic sinusitis because of an ectopic tooth in the roof of the left maxillary sinus in a 50-year-old female who presented with complaints of facial pain in the left maxillary region and purulent nasal discharge. The treatment of ectopic teeth usually consists of the removal of the previous, taking into account its location and possible risks. In this case, the close proximity to the orbit could have led to a greater risk of complications involving the infraorbital bundle. CT scan evaluation is frequently required to identify the exact location and is useful for treatment planning. The traditional surgical approaches to maxillary sinus pathology are transoral Caldwell-Luc approaches or transnasal endoscopic surgery. The method used in this case was the Caldwell-Luc approach. Although more invasive, it allows visualization into the maxillary sinus and superior access for instrumentation of the posterolateral region while permitting manipulation and removal of larger objects. Despite maxillary sinus ectopic teeth being uncommon, it is important for clinicians to become aware and to consider this entity to provide early adequate treatment.

Keywords: caldwell-luc approach; chronic sinusitis; dental surgery; ectopic tooth; maxillary sinus; maxillofacial surgery; sinusitis.

Figure 1. Preoperative maxillofacial CT scan

Axial view of preoperative maxillofacial CT scan showing an isodense area with complete obliteration of left maxillary sinus and an ectopic tooth (arrow) in the posterior portion of the roof of the sinus

Figure 2. Preoperative dentascan

Dentascan cross-sectional views of the maxilla showing an ectopic tooth (arrows) in the roof of the left maxillary sinus and a fluid-filled sinus

Figure 3. Three-dimensional reconstruction of preoperative maxillofacial CT scan

Three-dimensional view of CT scan showing a highlighted ectopic tooth encroaching the posterosuperior wall of the left maxillary sinus

Figure 4. Intraoperative image of surgical approach and ectopic tooth

Intraoperative image of Caldwell-Luc approach showing vestibular incision, osteotomy in the premolar region, and ectopic tooth in the maxillary sinus (arrow)

Figure 5. Extracted ectopic tooth

Ectopic tooth removed from the left maxillary sinus