Unusual Presentation of a Tooth in a 9-year-old Child with Cleft Lip - - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/269036311

Unusual Presentation of a Tooth in a 9-year-old Child with Cleft Lip and Palate: A Case Report

Article in Orthodontic review · October 2014

DOI: 10.12968/ortu.2014.7.4.135

CITATIONS READS

204

3 authors, including: Nadine Y Houghton University of Leeds

15 PUBLICATIONS 46 CITATIONS

SEE PROFILE

All content following this page was uploaded by Nadine Y Houghton on 02 December 2014.

The user has requested enhancement of the downloaded file.

Orthodontics 135 October 2014

Unusual Presentation of a Tooth in a 9-year-old Child with Cleft Lip and Palate: A Case Report

Abstract: Intranasal teeth are an uncommon but definite association with cleft lip and palate.1 The age of patients and the clinical symptoms surrounding their presentation can vary, as well as their management. A case report of a 9 year-old female with right-sided unilateral cleft lip and palate and associated intranasally erupting supernumerary tooth is presented here. Clinical Relevance: This case report illustrates that, in cleft lip and palate patients, teeth may present in unusual sites. Ortho Update 2014; 7: 135–136 Katie Edwards, BChD, Longitudinal Dental Foundation Trainee, Nadine Houghton, MDSc, BDS, MFDS, FDS(Orth), MOrth RCS, Consultant Orthodontist, Laura Mitchell, MBE, MDS, BDS, FDS RCPS(Glasg), FDS RCS(Eng), FGDP(UK), DOrth RCS(Eng), MOrth RCS(Eng), Consultant Orthodontist, St Luke’s Hospital, Little Horton Lane, Bradford, West Yorkshire BD5 0NA, UK. Cleft lip and palate is the most common craniofacial malformation with a reported worldwide incidence of 1.7 per 1000 live births.2 While the severity of each individual cleft can vary, the principles behind the treatment are the same. In the United Kingdom, primary lip repair is undertaken at around 3 months of age, with affected palates undergoing primary repair at approximately 9 months. Ectopic teeth are not uncommon in patients who have cleft lip and palate. In the general population, the ectopic development of teeth has been reported in a number of locations around the oral cavity including the palate,3 maxillary sinus,4 condyle,5 coronoid process,6 orbital floor7 and nasal cavity.8 Nasally erupting teeth can be due to trauma,9 cleft lip and palate,10 or idiopathic causes.11 They are an uncommon

Katie Edwards

complication of cleft lip and palate and, subsequently, there are only a few reported cases in recent literature.10 The aetiology behind cleft lip and palate associated intranasal teeth is not fully understood owing to the limited number of well-documented cases. It has been hypothesized that, during the incomplete formation of embryonic processes, a tooth germ can be displaced from its ideal location. This can subsequently be further malpositioned by extensive surgical procedures, and result in ectopic eruption into the nasal cavity.12 Intranasal teeth are occasionally asymptomatic12 and discovered as an incidental finding following routine clinical and radiological investigations. More frequently, they present with a diverse range of clinical symptoms, including nasal

• bstruction,13 congestion14 and discharge,15

recurrent epistaxis,16 and pain.17 The teeth themselves can be deciduous, permanent or supernumerary.8,12,14 The treatment of intranasal teeth involves their removal to alleviate symptoms and reduce the potential for further

• complications. This is followed by cosmetic

surgery, if required.17 In one reported case, the intranasal tooth was left in situ. The literature suggests that, in these instances, routine radiological monitoring should be undertaken.11,14

Case report

The subject of this case report was a 9-year-old female with a right-sided unilateral cleft lip and palate, under the care

• f the orthodontic department at St Luke’s

Hospital, Bradford. Her previous treatment had involved surgical repair of the right-

Nadine Houghton and Laura Mitchell

136 Orthodontics October 2014 sided unilateral cleft lip at 4 months of age and then the cleft palate at 10 months. She had been attending the orthodontic department over the previous 15 months, for both arch expansion and the use of a sectional fixed appliance in the upper arch to reposition a malpositioned and distally inclined UR1, which was causing labial ulceration, and to create space in preparation for an alveolar bone graft. The patient reported a new complaint of a tooth growing into her nasal cavity. The surrounding nasal area was tender to touch and nose wiping was reportedly sore. Clinically, an object which appeared to be the crown of a tooth could be seen up the patient’s right nostril (Figures 1 and 2). While an OPG radiograph (Figure 3) taken was diagnostically inconclusive of an intranasal tooth, a lateral cephalogram (Figure 4) clearly showed the presence of two odontome-like structures positioned in the nasal cavity. The patient was reviewed at the subsequent cleft lip and palate clinic with the cleft surgeon, where it was decided to remove the supernumerary teeth under general anaesthetic via a nasal approach. This case illustrates that, particularly in cleft lip and palate patients, teeth may present in unexpected positions. It also highlights the value of taking two radiographs, at a 90° angle to each other, to aid the localization of ectopic teeth; as well as demonstrating that panoramic radiographs do not always clearly show the presence of ectopic teeth that lie outside the focal trough.

References

1. Medeiros et al. Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate. Cleft Palate-Cran J 2000; 37(3): 271–273. 2. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw

• WC. Cleft lip and palate. Lancet 2009; 374(9703):

1773–1785. Epub 2009. 3. Usiskin LA. Management of the palatal ectopic and unerupted maxillary canine. Br J Orthod 1991; 18(4): 339–346. 4. Buyukkurt MC, Omezli MM, Miloglu O. Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109(1): 67–71. 5. Pace C, Holt D, Payne M. An unusual presentation

• f an ectopic third molar in the condylar region.

Aust Dent J 2010; 55(3): 325–327. 6. Okada H, Miyake S, Toyama K, Yamamoto H. Intraosseous tooth migration of impacted mandibular premolar: computed tomography

• bservation of 2 cases of migration into the

mandibular neck and the coronoid process. J Oral Maxillofac Surg 2002; 60(6): 686–689. Figure 4. Lateral cephalogram radiograph showing supernumerary tooth in nasal cavity. Figure 3. OPG radiograph diagnostically inconclusive of supernumerary tooth in nasal cavity. Figure 2. Clinical presentation of supernumerary tooth erupting into nasal cavity – intranasal view. Figure 1. Clinical presentation of supernumerary tooth erupting into nasal cavity – facial view. 7. Savundranayagam A. A migratory third molar erupting into the lower border of orbit causing blindness in the left eye. Aust Dent J. 1972; 17(6): 418–420. 8. Lin IH, Hwang CF, Su CY, Kao YF, Peng JP . Intranasal tooth: report of three cases. Chang Gung Med J 2004; 27(5): 385–389. 9. Gilbride MJ, Smith WP . Eruption of teeth in the nose following trauma to the primary and permanent

• dentitions. Br Dent J 2005; 198(4): 199–200.

10. Gupta YK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: case report and literature review. Int J Paediatr Dent 2001; 11(3): 221–224. 11. Smith RA, Gordon NC, De Luchi SF. Intranasal teeth: report of 2 cases and review of literature. Oral Surg Oral Med Oral Pathol 1979; 47: 120–122. 12. King NM, Lee AM. An intranasal tooth in a patient with a cleft lip and palate: report of case. J Am Dent Assoc 1987; 114(4): 475–478. 13. Yeung KH, Lee KH. Intranasal tooth in a patient with a cleft lip and alveolus. Cleft Palate-Cran J 1996; 33(2): 157–159. 14. Carver DD, Peterson S, Owens T. Intranasal teeth: a case report. Oral Surg Oral Med Oral Pathol 1990; 70(6): 804–805. 15. Ranalli DN, McWilliams BJ, Garrett WS Jr. Tooth and foreign object in the nasal fossa of a child with a cleft: case report. Pediatr Dent 1990; 12(3): 183–184. 16. Johnson AP . A case of an intranasal canine tooth. J Laryngol Otol 1970; 84: 533–535. 17. Kakade A, Gandhy MM, Damle SG. Management

• f nasally erupting deciduous canine in
• perated cleft lip and alveolus patient. J Ind Soc

Pedodont Prevent Dent 2006; 24(1): 40–41.