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CASE REPORT
Year : 2006  |  Volume : 24  |  Issue : 1  |  Page : 40-41
 

Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient


Paediatric Department, Nair Hospital Dental College, Mumbai, India

Correspondence Address:
Adesh Kakade
Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai - 400 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.22834

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  Abstract 

Nasally erupting tooth is a rare finding seen associated with cleft lip and alveolus. It may be diagnosed as a result of symptoms such as difficulty in breathing, pain on sneezing or blowing the nose or may remain asymptomatic. A case of a 4 year old male child operated for bilateral cleft lip and alveolus with unilateral right sided nasally erupting deciduous canine is presented here.


Keywords: Deciduous canine, Eruption, Intranasal


How to cite this article:
Kakade A, Gandhy M M, Damle S G. Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient. J Indian Soc Pedod Prev Dent 2006;24:40-1

How to cite this URL:
Kakade A, Gandhy M M, Damle S G. Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2020 Jan 19];24:40-1. Available from: http://www.jisppd.com/text.asp?2006/24/1/40/22834


The occurrence of a cleft lip and palate is not a rare phenomenon with a prevalence of 1 in 800 births.[1] Most children are operated for cleft lip correction by 6 months and cleft alveolus by a year and half. Despite the corrective procedures, these children suffer a number of dental and skeletal abnormalities such as anodontia, oligodontia, supernumerary teeth, delayed or premature eruption and maxillary arch hypoplasia.[2] One of the rare complication of cleft lip and alveolus is nasally erupting tooth.[3] There are only 6 cases reported in literature in which intranasal teeth were present in patients with cleft lip and palate.[3],[4],[5],[6],[7],[8] Nasally erupting teeth may be incidently diagnosed on routine radiographic examination or by presence of symptoms such as difficulty in breathing, pain on sneezing or while blowing the nose.[3],[5],[6],[7] The prevalence of nasally erupting tooth as a result of cleft lip and alveolus is about 0.61% in bilateral cleft lip and palate, 0.40% in unilateral cleft lip and palate. It is seen to occur more in females than males.[9] Presented here is a case of a 4 year old male child with operated bilateral cleft lip and palate and unilateral nasally erupting deciduous right canine in the nasal cavity.


  Case Report Top


A 4 year old male child operated for bilateral cleft lip at 6 months and bilateral cleft alveolus at 1 and half year was referred by an ENT consultant to department of Paediatric dentistry, Nair Hospital Dental College with the chief complaint of pain in the nose while blowing [Figure - 1]. The mother reported that she felt a hard object on the right nasal floor while cleaning the child's nose. The clinical examination revealed nasally by an erupting tooth and nasally erupting deciduous canine [Figure - 2].

The extraction of the nasally erupting deciduous canine was planned under general anaesthesia after reviewing the child's age and medical records. Routine blood and urine investigation and chest X-ray were done and were within normal limits. The plastic surgeon was consulted to carry out cosmetic surgical closure of the communication between oral and nasal cavities after the extraction, at a later date. Inhalation anaesthesia - sevoflurane was administered by anaesthesiologists after endotracheal intubation via the left nostril. The tooth was extracted thereafter from the nasal aspect after securing the tooth with a sterile silk thread to prevent accidental aspiration or ingestion. Follow-up was maintained to monitor healing [Figure - 3][Figure - 4].


  Discussion Top


An intranasally erupting tooth could be a result of cleft lip and alveolus, traumatic injuries or idiopathic.[5],[10] The nasally erupting tooth could be deciduous, permanent or supernumerary. Smith et al reported 2 cases and identified 32 documented cases of intranasal teeth as a result of varying etiology from cleft to trauma to genetics. Out of the cases identified, 15 were found to be permanent teeth, 2 deciduous teeth and 17 were supernumerary teeth.[5] Since then, only 25 cases have been reported with intranasal teeth and 6 of these were found in children with cleft lip and palate.[3]

The treatment in all cases remains the same - extraction followed by cosmetic surgery if required. The parents should be given all the details of the condition involving the tooth and what would be the further course of treatment. In case of a supernumerary tooth, there is no problem as a full complement of teeth would erupt unhampered while in case of permanent tooth extraction, further prosthetic rehabilitation would be required. In case of deciduous tooth extraction, as in case presented, a regular follow-up is needed to observe the presence, development and eruption of the permanent successor tooth.[8]

 
  References Top

1.Damle SG. Textbook of Pediatric dentistry. 2nd edn. Arya Med Publishing House: Delhi, India.  Back to cited text no. 1    
2.Harris EF, Hullings JG. Delayed dental development in children with cleft lip and palate. Arch Oral Biol 1990;35:469-473  Back to cited text no. 2  [PUBMED]  
3.GuptaYK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a 4year old child: a case report and literature review. Int J Paediatr Dent 2001;11:221-4.  Back to cited text no. 3    
4.Lin IH, Hwang CF, Su CY, Kao YF, Peng JP. Intranasal tooth: report of 3 cases. Chang Gung Med J 2004;27:385-9.  Back to cited text no. 4  [PUBMED]  
5.Smith RA, Gordon NC, De Luchi SF. Intranasal teeth: report of 2 cases and review of literature. Oral Surg Oral Med Oral Pathol 1979;47:120-2.  Back to cited text no. 5  [PUBMED]  
6.Ranalli DN, McWilliams BJ, Gorrett WS Jr. Tooth and foreign object in nasal fossa of a child with cleft: case report. Pediatr Dent 1990;12:183-4.  Back to cited text no. 6    
7.Yeung KH, Lee KH. Intranasal tooth in a patient with a cleft lip and alveolus. Cleft Palate Craniofac J 1996;33:157-9.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.King NM, Lee AM. An intranasal tooth in a patient with cleft lip and palate: a report of a case. J Am Dent Assoc 1987;114:475-8.  Back to cited text no. 8  [PUBMED]  
9.Medeiros AS, Gomide MR, Costa B, Carrara CF, Das Neves LT. Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate. Cleft Palate Craniofac J 2000;37:271-3.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Gilbride MJ, Smith WP. Eruption of teeth in the nose following trauma to primary and permanent dentitions. Br Dent J 2005;198:199-200.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


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