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 0 204 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.

October 2014 Orthodontics 135 Katie Edwards Nadine Houghton and Laura Mitchell 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 Cleft lip and palate is the most common complication of cleft lip and palate and, recurrent epistaxis, 16 and pain. 17 The teeth craniofacial malformation with a reported subsequently, there are only a few reported themselves can be deciduous, permanent or worldwide incidence of 1.7 per 1000 live cases in recent literature. 10 supernumerary. 8,12,14 births. 2 While the severity of each individual The aetiology behind cleft lip The treatment of intranasal teeth cleft can vary, the principles behind the and palate associated intranasal teeth is involves their removal to alleviate symptoms treatment are the same. In the United not fully understood owing to the limited and reduce the potential for further Kingdom, primary lip repair is undertaken number of well-documented cases. It complications. This is followed by cosmetic at around 3 months of age, with affected has been hypothesized that, during the surgery, if required. 17 In one reported case, palates undergoing primary repair at incomplete formation of embryonic the intranasal tooth was left in situ . The approximately 9 months. processes, a tooth germ can be displaced literature suggests that, in these instances, Ectopic teeth are not uncommon from its ideal location. This can subsequently routine radiological monitoring should be in patients who have cleft lip and palate. be further malpositioned by extensive undertaken. 11,14 In the general population, the ectopic surgical procedures, and result in ectopic eruption into the nasal cavity. 12 development of teeth has been reported Case report in a number of locations around the oral Intranasal teeth are occasionally The subject of this case report cavity including the palate, 3 maxillary sinus, 4 asymptomatic 12 and discovered as an was a 9-year-old female with a right-sided condyle, 5 coronoid process, 6 orbital floor 7 incidental finding following routine clinical unilateral cleft lip and palate, under the care and nasal cavity. 8 and radiological investigations. More of the orthodontic department at St Luke’s Nasally erupting teeth can be frequently, they present with a diverse Hospital, Bradford. Her previous treatment due to trauma, 9 cleft lip and palate, 10 or range of clinical symptoms, including nasal had involved surgical repair of the right- idiopathic causes. 11 They are an uncommon obstruction, 13 congestion 14 and discharge, 15 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.

October 2014 136 Orthodontics 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 Figure 1 . Clinical presentation of supernumerary a tooth growing into her nasal cavity. The Figure 2 . Clinical presentation of supernumerary tooth erupting into nasal cavity – facial view. tooth erupting into nasal cavity – intranasal view. 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. Figure 3 . OPG radiograph diagnostically inconclusive of supernumerary tooth in nasal cavity. 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 9. Gilbride MJ, Smith WP . Eruption of teeth in the nose presence of ectopic teeth that lie outside the following trauma to the primary and permanent focal trough. dentitions. Br Dent J 2005; 198 (4): 199–200. 10. Gupta YK, Shah N. Intranasal tooth as a References complication of cleft lip and alveolus in a four year old child: case report and literature review. 1. Medeiros et al . Prevalence of intranasal ectopic Int J Paediatr Dent 2001; 11 (3): 221–224. teeth in children with complete unilateral and 11. Smith RA, Gordon NC, De Luchi SF. Intranasal bilateral cleft lip and palate. Cleft Palate-Cran J teeth: report of 2 cases and review of literature. 2000; 37 (3): 271–273. Oral Surg Oral Med Oral Pathol 1979; 47 : 120–122. 2. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw 12. King NM, Lee AM. An intranasal tooth in a WC. Cleft lip and palate. Lancet 2009; 374 (9703): patient with a cleft lip and palate: report of case. 1773–1785. Epub 2009. J Am Dent Assoc 1987; 114 (4): 475–478. 3. Usiskin LA. Management of the palatal ectopic 13. Yeung KH, Lee KH. Intranasal tooth in a patient and unerupted maxillary canine. Br J Orthod with a cleft lip and alveolus. Cleft Palate-Cran J 1991; 18 (4): 339–346. 1996; 33 (2): 157–159. 4. Buyukkurt MC, Omezli MM, Miloglu O. 14. Carver DD, Peterson S, Owens T. Intranasal teeth: Dentigerous cyst associated with an ectopic tooth a case report. Oral Surg Oral Med Oral Pathol Figure 4 . Lateral cephalogram radiograph in the maxillary sinus: a report of 3 cases and 1990; 70 (6): 804–805. showing supernumerary tooth in nasal cavity. review of the literature. Oral Surg Oral Med Oral 15. Ranalli DN, McWilliams BJ, Garrett WS Jr. Tooth Pathol Oral Radiol Endod 2010; 109 (1): 67–71. and foreign object in the nasal fossa of a child 5. Pace C, Holt D, Payne M. An unusual presentation with a cleft: case report. Pediatr Dent 1990; 12 (3): of an ectopic third molar in the condylar region. 7. Savundranayagam A. A migratory third molar 183–184. Aust Dent J 2010; 55 (3): 325–327. erupting into the lower border of orbit causing 16. Johnson AP . A case of an intranasal canine tooth. 6. Okada H, Miyake S, Toyama K, Yamamoto H. blindness in the left eye. Aust Dent J . 1972; 17 (6): J Laryngol Otol 1970; 84 : 533–535. Intraosseous tooth migration of impacted 418–420. 17. Kakade A, Gandhy MM, Damle SG. Management mandibular premolar: computed tomography 8. Lin IH, Hwang CF, Su CY, Kao YF, Peng JP . of nasally erupting deciduous canine in observation of 2 cases of migration into the Intranasal tooth: report of three cases. Chang operated cleft lip and alveolus patient. J Ind Soc mandibular neck and the coronoid process. Gung Med J 2004; 27 (5): 385–389. Pedodont Prevent Dent 2006; 24 (1): 40–41. J Oral Maxillofac Surg 2002; 60 (6): 686–689. View publication stats View publication stats