Osteoma and Ectopic Tooth of the Left Maxillary Sinus: A Unique Coexistence

Abstract

Background: Ectopic eruption of a tooth or osteoma rarely occurs within the maxillary sinus. Coexistence of these two rare entities in the maxillary sinus has never been reported in the English literature. Case Report: Herein, we present a 21 year-old male patient with osteoma and ectopic tooth in the left maxillary sinus treated with the removal of the ectopic tooth by endoscopic sinus surgery and excision of the osteoma by the CaldwellLuc procedure. Conclusion: Unique coexistence of two different entities in the maxillary sinus is most likely due to pediatric facial trauma. Pediatric patients with maxillofacial trauma should be carefully watched for dental injury both clinically and radiologically. Keywords: Ectopic tooth, maxillary sinus, osteoma Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633:473-6 Osteomas are benign, slow-growing tumors of the bone and consist of mature compact or cancellous bone (1). These are the most common benign tumors of paranasal sinuses (1). The most common region is frontal sinus (1). Maxillary sinus is a rare localization for osteoma (1). Ectopic teeth are located in areas other than the alveolar arch and are infrequently seen in the maxillary sinus (2). To the best of our knowledge, this paper is the first to present the combination of two rare entities within the maxillary sinus. We also discussed the possible etiologic factors and surgical management. CASE PRESENTATIONA 21 year-old male presented with the complaints of pain and feeling of pressure, especially during biting over the left cheek for the past two months. He had a history of sinus infection not responding to antibiotics in this period. In detailed medical history, the patient mentioned a maxillofacial injury due to falling down at the age of ten which was treated with debridement and suturing of wounds. Intraoral examination showed that the upper third molar was absent and the patient had a small draining oro-antral fistula in this location (Figure 1). Endoscopic nasal examination of the nasal cavity showed normal nasal mucosa. The remainder of the examinations were also within normal limits. An orthopantomogram was initially performed for the missing upper left third molar, which showed that the ectopic third molar was located just above a radiopaque mass in the left upper jaw (Figure 2).In order to determine the exact location of the ectopic third molar and radiopaque mass, computed tomography (CT) of the paranasal sinuses was performed. In the coronal cross-section, a fully developed ectopic third molar and underlying hyperdense mass were seen in the left maxillary sinus. The welldefined mass under the ectopic third molar was 15x25 mm in size and compatible with the compact bone. This osseous mass was located in the inferior portion of the maxillary sinus and near the alveolar arch (Figure 3). The left maxillary sinus volume was increased and nasal septum was deviated to the right side. The ectopic third molar was adjacent to the posterior maxillary sinus wall and orbital floor, b...

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