When you’re sick, having a is pretty much the worse: You can’t breathe, you can’t taste or smell, you can’t sleep … but thankfully, these symptoms only last a few days. Now, imagine having those symptoms for two years straight. Then, imagine being told by a doctor that the cause is a random tooth growing in your nasal cavity.
Yes, this really happened, and it’s the subject of an article in the new BMJ Case Reports—complete with photos. Here’s what happened, and how it all shook out.
A 59-year-old man was referred to the otorhinolaryngology (AKA ear-nose-throat) department at the University Hospital Aarhus in Denmark, where he told his doctors about a two-year history of nasal congestion, chronic discharge from his nose, and difficulty smelling and tasting. The symptoms occurred mainly on the left side of his nose, and he’d tried topical nasal steroids with no improvement.
During a physical exam, doctors noted that the patient had a deviated septum—meaning his nasal canal was off-centered—along with some type of mass in the floor of his nasal cavity. The mass had to come out, his doctors decided, so they scheduled a CT scan and a surgery. They also instructed the patient to take antibiotics, and practice nasal irrigation, for 10 days beforehand.
The CT scan provided a little more clarity, and doctors were able to make out a 13 millimeter by 6 millimeter tumor covered by the lining of the nasal cavity. They suspected that the mass might be a cyst, an impacted tooth, or some other foreign body that made its way into the sinuses, but they wouldn’t know for sure until they operated.
While the patient was under general anesthesia, surgeons used a tiny camera (inserted through the nose) to find the mass, and forceps to extract it. While they were at it, they also removed a nearby bone spur and straightened out the patient’s deviated septum.
The mass was sent to a lab, which confirmed that it was, indeed, a tooth. This is rare, the authors of the case report point out, occurring in just 0.1 to 1% of the general population. In fact, only 23 cases were reported in medical journals between 1959 and 2008.
When it does happen, this phenomenon is known as an “intranasal retained tooth.” It can occur in children and adults, according to the case report, and has been diagnosed slightly more in males than in females. It’s not entirely clear why it happens, but research suggests that infections or developmental disturbances (like a cleft lip or cleft palate) can play a role.
In other cases, intranasal teeth have been discovered after patients suffered some type of facial trauma. “A displaced tooth might later erupt into the nasal cavity,” the authors wrote. Their patient did have a broken jawbone and nose earlier in life, but “there was no evidence of bone or tooth involvement,” they wrote, “making a connection unlikely in the present case.”
Once the tooth makes its way into the nasal cavity, it’s not just the mass itself that causes problems; the immune system, detecting something that shouldn’t be there, also triggers an inflammatory response.
And while some people with intranasal teeth can have no symptoms at all, many do report congestion, discharge, nosebleeds, facial pain, nasal swelling, or the feeling that something is stuck in their nose. (Go figure.)
“Our patient most likely had the intranasal retained tooth most of his life,” the authors wrote, “but had late onset of symptoms.” Fortunately, extraction of the tooth cleared up the man’s congestion and chronically runny nose, and he reported feeling much better just one month later.
So why are his doctors telling us all this? “We find it to be a relevant reminder of a rare condition,” they wrote. (Plus, the photos are pretty fascinating.) “Intranasal teeth are a rare finding, but important to recognize,” they added—especially since it can be missed or misdiagnosed as allergies, chronic sinusitis, or a variety of other conditions.
The symptoms caused by an intranasal tooth can seriously decrease quality of life, the authors concluded. But proper diagnosis, and minimally invasive surgery, can be an easy and safe way to help people breathe easily once more.
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