Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 730

Table of Contents
Year : 2011  |  Volume : 2  |  Issue : 2  |  Page : 222-224  

Ectopic third molar in the maxillary sinus

K. D. Dental College and Hospital, NH 2 Chatikara, Mathura, Uttar Pradesh, India

Date of Web Publication31-Mar-2012

Correspondence Address:
Shishir Mohan
K. D. Dental College and Hospital, NH 2 Chatikara, Mathura - 281 006, Uttar Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-5950.94488

Rights and Permissions

Ectopic eruption of teeth into a region other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin and maxillary sinus. Occasionally, a tooth may erupt in the maxillary sinus and present with local sinonasal symptoms attributed to chronic sinusitis. We present a case of an ectopic maxillary third molar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus.

Keywords: Ectopic eruption, maxillary antrum, third molar

How to cite this article:
Mohan S, Kankariya H, Harjani B, Sharma H. Ectopic third molar in the maxillary sinus. Natl J Maxillofac Surg 2011;2:222-4

How to cite this URL:
Mohan S, Kankariya H, Harjani B, Sharma H. Ectopic third molar in the maxillary sinus. Natl J Maxillofac Surg [serial online] 2011 [cited 2022 Sep 30];2:222-4. Available from: https://www.njms.in/text.asp?2011/2/2/222/94488

   Introduction Top

Tooth development results from a complicated multi-step interaction between the oral epithelium and the underlying mesenchymal tissue. A series of complex tissue interactions result in the formation of mature teeth. Abnormal tissue interactions during tooth development may potentially result in ectopic tooth development and eruption. [1]

Ectopic eruption of a tooth into the dental environment is common, whereas ectopic eruption of a tooth in other sites is rare. [2] One such site for ectopic tooth eruption in a nondental location is the maxillary sinus. [3] Due to its rarity, there is a dearth of literature discussing this entity. [4] Ectopic eruption may result due to one of the three processes: developmental disturbance, pathological process and iatrogenic activity. [4] Tooth eruption into the maxillary sinus may cause sinusitis, [4] the treatment of which (if infected) is surgical removal. [1] We present a case of an ectopic maxillary third molar, which presented in the right maxillary sinus with purulent rhinorrhea and was removed via a Caldwell-Luc procedure.

   Case Report Top

A 28-year-old female reported with a complaint of recurrent purulent rhinorrhea on the right side with associated pain and swelling of 6 months duration [Figure 1]. The problem did not resolve in spite of taking several courses of antibiotics prescribed by medical practitioners. On examination, swelling was noted extending from ala of nose to zygomatic prominence, obliterating nasolabial fold of the right side. Swelling was tender. Intraoral examination revealed swelling from right lateral incisor to second molar region, obliterating the vestibule. No carious tooth was noted in the involved quadrant. All teeth were found vital as confirmed by vitality test in the right upper quadrant. Right upper third molar was missing and there was no history of any previous extraction. Swelling was tender and fluctuant. Aspiration revealed seropurulent fluid. Orthopantomogram (OPG) [Figure 2] confirmed the presence of an ectopic molar tooth in the superomedial aspect of the right maxillary antrum.
Figure 1: Swelling on right side of the face

Click here to view
Figure 2: OPG shows tooth in sinus

Click here to view

The patient subsequently underwent removal of the ectopic tooth under sedation and local anesthesia via a Caldwell-Luc procedure. A vestibular incision was made from lateral incisor up to the first molar tooth. A bony window was created [Figure 3] and a cystic lining was noticed. Enucleation of the cyst was done; the lining was attached with medial wall of maxillary sinus which was thinned out and came out along with the lining [Figure 4]. Hemostasis was achieved by placing a pack, and the wound closed with 3.0 silk suture [Figure 5]. The pack was removed on 3 rd postoperative day and primary closure was done. On the 10 th day, swelling completely subsided. Histopathology of the soft tissue revealed a dentigerous cyst with no evidence of malignancy. There was no discharge from the nose. The patient has been asymptomatic over a year's follow-up.
Figure 3: Bony window made in anterior wall of sinus

Click here to view
Figure 4: Incision closed pack removed through separate stab incision

Click here to view
Figure 5: Pathological specimen with removed tooth

Click here to view

   Discussion Top

Tooth development results from an interaction between the oral epithelium and the underlying mesenchymal tissue. This process begins in the 6 th week in utero with the formation of maxillary and mandibular dental lamina in the region of the future alveolar process. This ectodermal derivative undergoes proliferation to form the permanent dentition between the 5 th and 10 th months, with each mature tooth consisting of a crown and a root. [5] Abnormal tissue interactions during development may potentially result in ectopic tooth development and eruption. Ectopic eruption of a tooth into a region other than the oral cavity is rare although there have been reports of tooth in the nasal septum, [6] mandibular condyle, [7] coronoid process [8] and the palate. [9] Occasionally, the tooth may erupt into the maxillary antrum and present with local sinonasal symptoms attributed to recurrent or chronic sinusitis. The diagnosis of this condition can be made radiographically with plain sinus X-rays and computed tomography (CT) scans taken in axial and coronal sections.

Dentigerous cyst is the most common of all follicular cysts, more common in males, occurring in the second or third decade of life. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla. [10] If infected, the treatment of choice is complete enucleation of the lesion intraorally with removal of the associated tooth. It is also important to completely remove all diseased antral tissues and thoroughly assess all resected soft tissue histologically. [11] Only a few cases of "ectopic" molars which have been displaced by progressively growing dentigerous cysts have been reported in medical literature. [12] It is believed that the displacement of tooth buds by the expansion of these dental cysts results in the displacement of the tooth to other areas, which is attributed to the ectopic appearance of the third molar in this patient. Recurrence and malignant or ameloblastic transformation following a dentigerous cyst is rare when compared to odentogenic keratocyst. [13],[14] Close observation and follow-up with periodic radiographs is required.

The treatment of an ectopic tooth in the maxillary sinus is usually removal because if left untreated, it has the tendency to form a cyst or tumor and/or the lesion may cause perforation of the orbital floor and obliteration of the nasal cavity. Caldwell-Luc procedure was followed in this case as the ectopic tooth was the cause of recurrent sinusitis and purulent rhinorrhea in spite of administering antibiotics repeatedly. The importance of ruling out related dental conditions in any patient presenting with such signs and symptoms of the head and neck region cannot be overemphasized.

   References Top

1.Goh YH. Ectopic eruption of maxillary molar tooth: An unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80-1.   Back to cited text no. 1
2.Elango S, Palaniappan SP. Ectopic tooth in the roof of the maxillary sinus. Ear Nose Throat J 1991;70:365-6.   Back to cited text no. 2
3.Goh YH. Ectopic eruption of maxillary molar tooth: An unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80-1.   Back to cited text no. 3
4.Bodner L, Tovi F, Bar-Ziv J. Teeth in the maxillary sinus: Imaging and management. J Laryngol Otol 1997;111:820-4.   Back to cited text no. 4
5.Avery JK. Oral Development and histology. 2 nd ed. New York: Theime Medical Publisher Inc; 1994. p. 70-92.   Back to cited text no. 5
6.el-Sayed Y. Sinonasal teeth. J Otolaryngol 1995;24:180-3.   Back to cited text no. 6
7.Yusuf H, Quayle AA. Intracondylar tooth. Int J Oral Maxillofac Surg 1989;18:323.   Back to cited text no. 7
8.Toranzo Fernandez M, Terrones Meraz MA. Infected cyst in the coronoid process. Oral Surg Oral Med Oral Pathol 1992;73:768.   Back to cited text no. 8
9.Pracy JP, Williams HO, Montgomery PQ. Nasal teeth. J Laryngol Otol 1992;106:366-7.   Back to cited text no. 9
10.Bhaskar SN. Synopsis of oral pathology. 7 th ed. United States: CBS Publisher: 1986. p. 228-37.   Back to cited text no. 10
11.Laskin DM. Oral surgery. 1 st ed. Missouri: Cr. Mosby: 1996. p. 459.   Back to cited text no. 11
12.Szerlip L. Displaced third molar with dentigerous cyst: An unusual case. J Oral Surg 1978;36:551-2.  Back to cited text no. 12
13.Kramer IR. Ameloblastoma: Clinicopathological appraisal. Br J Oral Surg 1963;1:13-28.   Back to cited text no. 13
14.Toller PA. Origin and growth of cyst of the jaws. Ann R Coll Surg Engl 1967;40:306-36.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

This article has been cited by
1 Ectopic Upper Third Molar in Maxillary Sinus: A Case Report and Literature Review
Raid M. Al-Ani, Tahrir N. Aldelaimi, Afrah A. Khalil
Indian Journal of Otolaryngology and Head & Neck Surgery. 2022;
[Pubmed] | [DOI]
2 Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature
Luan Mavriqi, Felice Lorusso, Gianluca Tartaglia, Francesco Inchingolo, Antonio Scarano
Antibiotics. 2022; 11(5): 658
[Pubmed] | [DOI]
3 Surgical approach of ectopic maxillary third molar avulsion: Systematic review and meta-analysis
R. Courtot,L. Devoize,A. Louvrier,B. Pereira,J. Caillet,C. Meyer,I. Barthélémy,A. Depeyre
Journal of Stomatology, Oral and Maxillofacial Surgery. 2021; 122(1): 77
[Pubmed] | [DOI]
4 Ectopic maxillary tooth as a cause of recurrent maxillary sinusitis: a case report and review of the literature
Ali Almomen,B Alkhudair,A Alkhatib,G Alazzah,Zainab Ali,Ibrahim Al Yaeesh,Ahmed AlOmairin,Abdullah Alshuaibi,Abdulelah AlBahr
Journal of Surgical Case Reports. 2020; 2020(9)
[Pubmed] | [DOI]
5 Ectopic Third Molar: A Hidden Cause For Maxillary Sinusitis—A Rare Case Report
Shoeb Kasim Jendi
Indian Journal of Otolaryngology and Head & Neck Surgery. 2019;
[Pubmed] | [DOI]
6 Unusual Case of Sinusitis Related to Ectopic Teeth in the Maxillary Sinus Roof/Orbital Floor: A Report
OtacílioLuiz Chagas Júnior,LucasBorin Moura,CamilaLeal Sonego,Eduardo Oliveira Campos de Farias,CarolineComis Giongo,Alisson André Robe Fonseca
Craniomaxillofacial Trauma & Reconstruction. 2016; 9(3): 260
[Pubmed] | [DOI]
7 An Incidentally Discovered Nasal Supernumerary Tooth
Muhammed Sedat Sakat,Korhan Kilic,Mustafa Sitki Gozeler,Harun Ucuncu,Ozan Kuduban
Journal of Craniofacial Surgery. 2015; 26(6): 2024
[Pubmed] | [DOI]
8 Maxillary dentigerous cyst associated with an ectopic third molar in the maxillary sinus: a literature review and report of six consecutive cases
S. Sivolella,S. Ricci,M. Busca,E. Stellini,M. Valente
Oral Surgery. 2014; : n/a
[Pubmed] | [DOI]
9 Chronic Maxillary Rhinosinusitis of Dental Origin: A Systematic Review of 674 Patient Cases
Jerome R. Lechien,Olivier Filleul,Pedro Costa de Araujo,Julien W. Hsieh,Gilbert Chantrain,Sven Saussez
International Journal of Otolaryngology. 2014; 2014: 1
[Pubmed] | [DOI]
10 Ectopic Tooth Superiorly Located in the Maxillary Sinus
Asli Datli,Ozgur Pilanci,Oguz Cortuk,Omer Saglam,Samet Vasfi Kuvat
The Journal of Craniofacial Surgery. 2014; 25(5): 1927
[Pubmed] | [DOI]
11 Infected Dentigerous Cyst of Maxillary Sinus Arising from an Ectopic Third Molar
Yadavalli Guruprasad,Dinesh Singh Chauhan,Umashankar Kura
Journal of Clinical Imaging Science. 2013; 3: 7
[Pubmed] | [DOI]
12 Ectopic premolar tooth in the maxillary sinus: A case report and review of literature
KS Gangadhara Somayaji,Aroor Rajeshwary,Sherwak Ramlan,MohammadNalapad Abdulla
Archives of Medicine and Health Sciences. 2013; 1(1): 48
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded561    
    Comments [Add]    
    Cited by others 12    

Recommend this journal