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Radiologic Findings of A Heterotopic Maxillary Third Molar
... The heterotopic teeth are rare phenomena, so the etiology is still not clear. 1 Various factors may cause heterotopic teeth like cleft lip-palate, traumas, cystic lesions, and maxillary infections. 2 When a heterotopic tooth is detected, teeth are generally located in the orbit, nasal cavity, maxillary sinuses, infratemporal fossa, condylar process, and mandibular ramus. 3,4 The most common heterotopic teeth are maxillary and mandibular third molars. ...
... Therefore, third molars are the most frequently encountered heterotopic teeth. 1,4 In the literature review of Iglesias et al. 8 covering the years 1980-2011, they collected 14 welldocumented clinical cases about ectopically located molar teeth. Of the detected teeth, 11 were reported as mandibular third molars, of which 5 were in the mandibular ramus and 6 were in the coronoid process. ...
... Consider-ing the age of individuals with heterotopic teeth, there were case reports presented at very different ages in the literature. 1,8 Since heterotopic teeth are usually asymptomatic, they can be detected incidentally in different age groups. It is likely to be detected at an earlier age in syndromic individuals and symptomatic patients. ...
Aim: Teeth that occur in distant places from the alveolar arch (maxillary sinus, orbit, infratemporal fossa, condylar region, etc.) because of various local or systemic factors are named heterotopic teeth. The heterotopic tooth is a rare phenomenon. Although the etiology is still unknown, it is known that it may be seen due to pathologies caused by cystic lesions, cleft lip-palate, trauma history, and infectious conditions. They are usually asymptomatic, so they are detected by chance in routine clinical and radiological examinations. This study aims to determine the frequency of heterotopic permanent teeth and their anatomical localization with the help of cone-beam computed tomography (CBCT). Methods: This study was retrospectively performed with CBCT slices. CBCT sections of 2590 individuals (1432 females, 1158 males) between the ages of 10-89 (mean: 44 ± 17 years) were evaluated in the study. Heterotopic teeth were investigated using coronal, axial, sagittal CBCT sections in regions distant from the maxillary-mandibular arch. SPSS V.21 software (IBM Corp., Armonk, NY, USA) was used for data analysis. Results: Heterotopic teeth were found in 10 of 2590 individuals (0.4%). All of the heterotopic teeth detected are molar teeth; 4 are mandibular third molar teeth, 5 are maxillary third molar teeth and 1 is maxillary second molar tooth. The frequency of heterotopic teeth according to gender did not show a statistically significant difference (4 females, 6 males) p> 0.05. The average age of individuals with heterotopic teeth is 35.3 (17-65 years). 4 of the heterotopic impacted teeth are located in the ramus and 6 in the maxillary sinus. Conclusions: The prevalence of heterotopic teeth is very rare (0.4%). The teeth with the highest frequency of heterotopia are the third molars. Heterotopic teeth do not have an anatomical location and gender that they prefer predominantly.
Accidental displacement of an impacted tooth into the infratemporal fossa (ITF) is a rare but serious complication because of the vulnerability of the surrounding anatomical structures. Here we present the case of a 40-year-old man who reported pain on the right side of his face. Panoramic radiography and cone-beam computed tomography revealed an impacted third molar and a supernumerary tooth positioned immediately below it. Under local anesthesia, the third molar was easily extracted; however, the supernumerary tooth was inadvertently displaced into the ITF. The position of the tooth was confirmed by radiographic examination, and it was immediately removed intraorally by expanding the flap and carefully dissecting the soft tissues. Clinical aspects of this rare complication were evaluated, with special emphasis on the reliability of imaging modalities and surgical techniques.
Dentigerous or follicular cysts of odontogenic origin are innocuous benign cysts that are often linked with the crowns of permanent teeth.
A dentigerous cyst circumventing permanent teeth fails to erupt and is often displaced into ectopic positions in the upper and lower jaw
in the maxillofacial region. In the maxilla or upper jaw region, the impacted teeth are often displaced and/or shift into the maxillary sinus
and apart from the nasal septum, mandibular condyle, coronoid process and the palate, to harbour such ectopic eruptions of teeth. We
report a rare case of an impacted left third molar of maxilla, associated with dentigerous cyst. The impacted tooth was embedded in the
anterosuperior part of the infratemporal space. The cyst along with the tooth was removed using a modified Caldwell Luc incision.
Wisdom tooth operations are sometimes accompanied by complications. This case report shows complications during upper jaw third molar removal. Expectable problems during oral surgery should be planned to be solved in advance. Displacement of the third molar during oral surgeries as a considerable complication is rarely discussed scientifically. A good design of flap, adequate power for extraction, and clear view on the surgical field are crucial. Three-dimensional radiographic diagnostics in terms of cone beam computed tomography is helpful after tooth displacement into the infratemporal fossa.
Impaction of a mandibular premolar is relatively uncommon. Ectopic placement is more unusual and there has been no discussion in the literature of an ectopic mandibular premolar in the coronoid process. In this case report, we present an impacted ectopic mandibular permanent premolar in the sigmoid notch (incisura mandibulae) region. Etiology of the tooth and treatment options are discussed and illustrated by Cone Beam Computed Tomography (CBCT) images.
To evaluate the etiopathogenesis, clinical features and surgical approaches for removal of ectopic third molars in the mandible.
We report a case of an impacted mandibular third molar dislocated on mandibular sigmoid notch. 20 cases of ectopic mandibular third molars reported in the English-language literature, identified from Pubmed and Medline databases are also reviewed.
Among the 20 article reported in the presented study, ectopic third molars were generally located in the condylar region. The common symptoms of the clinical examination were pain, trismus, swelling, temporomandibular joint syndroms or no symptoms.
Ectopic third molar may be asymptomatic initially with clinical manifestations, later on as adjacent structures are affected. The surgical approach must be carefully planned for the aim of choosing the more conservative technique that produces the minimum trauma to patients. Key words:Ectopic third molar, sigmoid notch, cyst.
Third molar presence in the infratemporal fossa is a rareevent and it has been reported previously only two times in the literature, except for the cases which arise from complicationsoccurring during the extraction of the impactedupper third molar. Due to the presence of important vesselbundles and nerves in this area, third molar removal requiresa correct surgical management in order to avoid manypossible serious side effects. We report an unusual case ofupper third molar detected in the infratemporal fossa, whichhas been thoroughly investigated radiologically and removedthrough a safe surgical approach.
Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature. But the ectopic eruption into the non dentate region is rare and scantly documented. The maxillary sinus is one such a non dentate region, apart from nasal septum, mandibular condyle, coronoid process and the palate, to accommodate such ectopic eruptions of teeth. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature and discussed. Early surgical intervention for removal of ectopic tooth along with enucleation of the associated cyst, if any, is the treatment of choice.
The ectopic eruption of the teeth into the nasal cavity is a rare phenomenon. We report a case of nasal tooth in the left nasal cavity in a 64-year-male. We describe the clinical and radiological findings of the case and discuss their etiology, diagnosis, complications and treatment.
Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle.
Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients.
Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined.
Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery.
Key words:Third molar, ectopic tooth, condyle, mandible.
Removal of an impacted superior third molar is usually a simple and uncomplicated procedure for an Oral and Maxillofacial Surgeon. Nevertheless, complications are possible and include infection, facial swallowing, trismus, wound dehiscence, root fracture or even orosinusal fistula. Iatrogenic displacement into the infratemporal fossa is frequently mentioned but rarely reported. This anatomical fossa includes several important structures such as the internal maxillary artery, the venous pterygoid plexus, the sphenopalatine nerve, the coronoid process of the mandible and the pterygoid muscles. Recommended treatment includes immediate surgical removal if possible or initial observation and secondary removal, as necessary, because of infection, limited mandibular movement, inability to extract the tooth, or the patient's psychological unease. Sometimes, the displaced tooth may spontaneously migrate inferiorly and becomes accessible intraorally. This report describes the location and secondary surgical removal of a left maxillary third molar displaced into the infratemporal fossa, two weeks after first attempt at extraction.
The surgical removal of impacted maxillary third molars is a procedure routinely carried out by dentists and oral surgeons, and it is usually associated with low rates of complications and morbidity. 1,2 These complications frequently include fracture of the tuberosity, tooth root fracture, perforation of the maxillary sinus, prolapse of the buccal fat pad, and displacement of the roots or tooth into the maxillary sinus, all of which may be easily managed. 2,3 Although the displacement of an entire tooth into the infratemporal fossa was once considered a rare complication, 3 it has been reported more frequently in the literature in the last 4 decades. 1,2,4-11 This case report describes the location and surgical removal of a left maxillary third molar displaced into the infratemporal fossa during an unsuccessful surgical removal by the patient's dental clinician. The diagnostic and treatment problems and the causes of this complication are also discussed.
Intranasal teeth are uncommon, with only a few reported cases in the past few decades. The clinical manifestations of an intranasal tooth are quite variable. Unilateral nasal obstruction is a common complaint, but even though nasal symptoms are present, an intranasal tooth can be an incidental finding during routine examination in patients without nasal discomfort. Although the diagnosis is not difficult to make, a complete workup that included radiological investigations is important before any surgery is attempted. Transnasal endoscopic surgical approaches have been described with no evidence of recurrence or complications in similar cases. Herein, three patients with an intranasal tooth are described, along with possible etiologies, potential complications, differential diagnoses and their treatments.
Objectives: Ectopic mandibular third molar is a rare condition, and information about its causes and characteristics is limited. Its etiology has not yet been completely clarified. This article reports two cases of ectopic mandibular third molar and reviews the literature on the clinical signs and symptoms and management of this condition. Material and methods: We searched in medline Pubmed (http:// www.ncbi.nlm.nih.gov/PubMed) for articles from 1979-2014 and almost non English papers were excluded. Results: We found 34 cases (37 ectopic teeth) reported in different locations in 11 men and 23 women. Mean age was 46.3 (range 22 to 80). Those cases were evaluated alongside the new clinical cases that we presented. The most possible cause of ectopic molars was related pathology such as odontogenic cyst. Conclusion: The results of this review suggest that displaced teeth must be removed if they cause symptoms. The surgical route should be designed according to the location and position of the third molar. Clinical relevance: Treatment of ectopic teeth should be carefully planned according to the potential for trauma caused by the surgery.
An ectopic supernumerary tooth causing the formation of rhinolith was never reported before in the medical literature. A 30 years old male patient presented to our hospital with one sided nasal obstruction, recurrent epistaxis, and nasal discharge. Anterior rhinoscopy, nasal endoscopy and X-ray paranasal sinuses revealed a rhinolith in the left nasal cavity. Preoperative evaluation and post operative examination of the specimen proved that the nidus of rhinolith was a supernumerary ectopic tooth.
The ectopic development of teeth has been reported in many locations including the nasal cavity, maxillary sinus and the chin. Ectopic teeth may be permanent, deciduous or supernumerary. A case is presented in which a supernumerary tooth erupted into the maxillary sinus of an 11 year old boy.
Objective
To determine the prevalence, types of teeth, and distribution of intracoronal resorption in permanent dentition in a large population.
Methods
A total of 9,570 panoramic radiographs were screened, and 2,922 unerupted teeth were examined.
Results
The prevalence of intracoronal dentine defects was 1.55% in subjects and 0.95% in teeth. The highest prevalence of intracoronal radiolucencies was noted in the mandibular second molar (9.5%), followed by the maxillary second premolar tooth (4.7%). To our knowledge, this is the first report of coronal radiolucency in maxillary supernumerary teeth. Of the lesions identified, 39.3% were two-thirds of the dentine thickness, and 21.4% included the enamel; 85.7% of the defects were located at the central aspect of the crown. Ectopically positioned teeth showing intracoronal resorption accounted for 14.3% of the cases.
Conclusions
Intracoronal resorption in an unerupted tooth occurs frequently and can be seen in more than one tooth in an individual. This condition is usually associated with not only an ectopic position but also resorption, which may be a progressive process. Dental clinicians should conduct periodic follow-ups, both clinical and radiographic, of these unerupted teeth.
Ectopic and supernumerary teeth occur in a wide variety of sites. Those that have been reported include the mandibular condyle, coronoid process, orbit, palate, nasal cavity and the maxillary antrum. Eruption of teeth into these sites is rare, and easily overlooked. We present two cases in which eruption of teeth into the nose and paranasal sinuses was associated with significant morbidity and show how this was relieved by appropriate surgery.
Eruption of a tooth into a nonoral environs is rare. Ectopic eruption of the tooth into the nasal cavity and chin has been reported before. This is a report of an ectopic third molar tooth in the roof of the maxillary sinus, which has not, to our knowledge, been reported before.
Identification of a resorptive lesion in an unerupted premolar is detailed in this report of a 10-year-old female. The lesion was discovered during a periodic recall examination. Early detection and treatment of this resorptive process will minimize its potentially destructive capacity. Radiographic inspection of this lesion in the preeruptive dentition should be routinely performed.
Ectopic eruption of teeth can occur in a wide variety of sites. These include the mandibular condyle, coronoid process, palate, nasal cavity and maxillary sinus. While this process is unusual, the detection of a third molar in the maxillary antrum is extremely rare. A case is presented of ectopic eruption of a third molar in the left maxillary sinus of a 35-year-old caucasian male giving rise to local morbidity.
This investigation stemmed from preliminary clinical observations from a school dental clinic, which suggested that a proportion of clinically undetected, radiolucent lesions on radiographs may originate as pre-eruptive intracoronal dentin defects. This study investigated the prevalence of such defects in orthopantomograms from a group of children and young adults.
A total of 1281 orthopantomograms with 11,767 unerupted permanent teeth were examined.
The prevalence of intracoronal dentin defects was 3% by subjects, and 0.5% by teeth; the highest prevalence being noted in the maxillary and mandibular first permanent molars. Most of the lesions occurred singly, and nearly half had extended to greater than two-thirds the width of dentin thickness. Ectopic positioning was significantly associated with this lesion.
Pre-eruptive intracoronal dentin defects occur at a significant prevalence rate. Increased awareness of this entity may improve diagnosis and allow early treatment.
A 17-year-old male presented with a 3-month history of cough associated with right-sided purulent rhinorrhoea and right facial pain. Nasal endoscopy confirmed the presence of mucopus from the right middle meatus. Plain sinus X-ray assessment showed the presence of an ectopic molar in the right antero-superior aspect of the maxillary sinus entrapped in soft tissue. Surgical removal of the tooth and the diseased antral tissue was undertaken via a Caldwell-Luc procedure with resolution of symptoms.
Two cases of inverted and impacted third molars are described. They were conservatively managed without surgery. Complications that may arise from surgical removal of inverted and impacted teeth must be carefully considered beforehand. These should be weighed against the benefit of surgical removal. The two cases are reported because impaction with inversion of a molar tooth is not common.
The ectopic eruption of the teeth into the nasal cavity is a rare phenomenon. We report cases: two involving the nasal cavity and one involving the hard palate and complicated by Aspergillus rhinitis. We describe the clinical and radiologic presentation of these cases and discuss their etiology, complications, diagnosis, and treatment.
The purpose of this case report is to describe an unusual presentation of multiple lesions of intracoronal resorption in the permanent teeth in a healthy boy. Longitudinal radiographs demonstrated that all 3 lesions were acquired after the crowns were completely formed. Unlike previous reports in which intracoronal radiolucencies have been found in unerupted teeth or in newly erupting teeth, one lesion in this case developed in a fully erupted tooth, which was differentiated from internal resorption and invasive cervical resorption of the root. All were considered idiopathic external resorption, but they demonstrated diversities in size, appearance, and involvement of pulp and the rate of progression. Conservative treatment was performed. All remained asymptomatic, showing normal root development. This case report indicates that intracoronal resorption is a condition demonstrating a diversity of clinical features.
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