A 38-year-old man sought medical attention after struggling to breathe through his right nostril for years. But the doctors at a Mount Sinai ear, nose, and throat clinic couldn’t find the source of the problem until they discovered a tooth growing inside his nose. Ectopic teeth have been known to grow in certain parts of the mouth but finding them in the nose is rare.
Growing Pains
The man’s case was recently documented in the New England Journal of Medicine. According to the doctors on staff at Mount Sinai, the man hadn’t suffered any blows to the face, and didn’t have any visible face or head abnormalities.
But he did appear to have a deviated septum, which is when the bone and cartilage that separates the nostrils is off-center or crooked, with bone-like growths protruding out of the back of his nose. The doctors found a 2 cm hole in his septum, which prompted them to perform a rhinoscopy exam.
During the exam, oral and maxillofacial surgeons Dr. Sagar Khanna and Dr. Michael Turner found “a hard, nontender, white mass” in the patient’s right nostril. It had all the qualities of an “inverted ectopic tooth,” an upside-down tooth in the wrong place.
“Computed tomography of the paranasal sinuses showed a well-defined, radiodense mass consistent with an inverted ectopic tooth in the nasal cavity, which was thought to explain the obstructive symptoms and septal perforation,” the study reads.
The patient “was shocked initially, and then happy to know that there was a solution to his issues,” said Khanna, who had never seen a case like this before. While blockages in the sinuses are usually related to the septum, “rarely do you find a foreign body causing obstructive symptoms,” he added.
The surgeons then removed the tooth, which turned out to be 4 millimeters long, without complications. The man started breathing normally again after just three months.
“Follow-up three months after surgery, the patient’s symptoms of nasal obstruction had resolved,” the study adds.
The report notes that most ectopic teeth grow inside the mouth, usually the roof or jawline, when there’s not enough room in the gumline. The condition affects anywhere from 0.1% to 1% of the population, per a 2019 study. Genetics tend to affect orthodontic issues. Women are also more likely to have ectopic teeth, which start growing in the utero.
However, it’s rare to find these rogue teeth affecting the sinuses. The phenomenon was previously documented by the National Health of Institute in 2013 when researchers discovered six cases of teeth growing in the maxilary sinus, or the cavities below the cheeks, above the teeth, and on the sides of the nose.
One patient, a 21-year-old woman, experienced pain and swelling over her cheek for a month, while another 48-year-old woman had heaviness and numbness near her left cheek and lip for months. The other patients included in the study didn’t have major symptoms, but their ectopic teeth were discovered during scans for other procedures.
Clinicians recommend removing stray teeth as quickly as possible even if they aren’t affecting the person’s breathing, as they could become cancerous.
“The main risk of this is that the tooth can bump into the roots of other adult teeth and cause damage, the authors wrote.
“Sometimes this can make them feel wobbly and eventually need to be removed. A cyst can also form around the buried tooth. Some people have a baby tooth left in their mouth, which has not been naturally pushed out by the buried adult tooth. This baby tooth over time may eventually be lost leaving a gap or require further dental treatment to replace it.”
