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Frontal mucocele caused by an ectopic maxillary tooth

Published online by Cambridge University Press:  25 September 2007

M A Buchanan ,
S E Prince  and
P R Prinsley
M A Buchanan*
Affiliation:
Department of Otorhinolaryngology, andNorfolk and Norwich University Hospital, Norwich, UK
S E Prince
Affiliation:
Department of Maxillo-Facial Surgery, Norfolk and Norwich University Hospital, Norwich, UK
P R Prinsley
Affiliation:
Department of Otorhinolaryngology, andNorfolk and Norwich University Hospital, Norwich, UK
*
Address for correspondence: Mr Malcolm A Buchanan, Beck House, 137B Cambridge Road, Great Shelford, Cambridge CB22 5JJ, UK. E-mail: malcolm_buchanan123@hotmail.com
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Abstract

Objective:

To present a previously unreported cause of frontal mucocele.

Case report:

A patient presented with a frontal mucocele and maxillary sinusitis. Computed tomography revealed an ectopic maxillary tooth as the cause of her signs and symptoms. Removal of the tooth by a Caldwell–Luc procedure facilitated resolution of the mucocele. Conventional treatment of mucoceles by endoscopic sinus surgery, and other rhinological sequelae of ectopic teeth, are considered.

Conclusion:

This is the first documented case of an ectopic tooth causing a frontal mucocele, and demonstrates how effectively the patient's symptoms resolved on removal of the tooth.

Keywords

Ectopic Tooth EruptionMucoceleFrontal SinusMaxillary SinusCaldwell-Luc
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 12 , December 2008 , pp. 1384 - 1385
Copyright
Copyright © JLO (1984) Limited 2007

Introduction

Mucoceles are epithelium-lined cavities containing mucus which completely occupy a paranasal sinus,Reference Gavioli, Grasso, Carinci, Amoroso and Pastore1 most commonly the frontal and ethmoidal. They occur due to obstruction of the sinus ostium, usually as a result of chronic sinusitis, trauma or endoscopic sinus surgery.Reference Picavet and Jorissen2 An online literature search using PubMed confirmed that the current report is the first documented case of frontal mucocele arising due to an ectopic maxillary sinus tooth.

Case report

A 39-year-old woman presented with an intermittent, painful swelling above her right eyelid (Figure 1). She had a history of recurrent, right-sided maxillary sinusitis, treated unsuccessfully with steroid nasal sprays and oral antibiotics.

Fig. 1 Clinical photograph demonstrating a right frontal mucocele (arrow).

A computed tomography (CT) scan of the patient's sinuses showed a soft tissue attenuation filling the right frontal sinus and recess, with a well defined bony defect in the sinus floor and soft tissue extending into the superomedial aspect of the right orbit anteriorly (Figure 2). These findings were consistent with a ‘Pott's puffy tumour’ or frontal mucocele. Of note was an ectopic, upper right third molar tooth in the right maxillary antrum as a focus for the patient's maxillary sinusitis and consequent frontal mucocele (Figure 3).

Fig. 2 Computed tomogram showing a bony defect in the floor of the right frontal sinus (arrow), through which the mucocele extended into the superomedial aspect of the right orbit.

Fig. 3 Computed tomogram demonstrating an ectopic tooth in the right maxillary antrum.

Under general anaesthesia, a Caldwell–Luc procedure was performed, as the tooth was embedded too laterally to be amenable to endoscopic removal. It was apparent that the upper right third molar tooth had developed in an abnormal position in association with its alveolar bone. The tooth was surgically removed. The patient made an uneventful recovery, and her frontal mucocele and symptoms of maxillary sinusitis resolved without further intervention.

Discussion

This is the first documented report of a frontal mucocele arising due to an ectopic maxillary sinus tooth. Even more surprising is the fact that the condition disappeared following removal of the offending tooth. Left untreated, erosion of the bony sinus wall by such a mucocele can lead to anterior cranial fossa and/or orbital invasion. Endoscopic sinus surgery is an effective conventional treatment,Reference Khong, Malhotra, Wormald and Selva3 and the external approach, with or without obliteration of the sinus, also has a useful role.Reference Gavioli, Grasso, Carinci, Amoroso and Pastore1 It is clear in this case that maxillary sinusitis predisposed to the development of the frontal mucocele, as a result of the ectopic tooth.

Ectopic teeth, in general, are common. Numerous sites for ectopic teeth have been reported, including the nasal cavity, chin, mandibular condyle, coronoid process, palate and maxillary sinus.Reference Hasbini, Hadi and Ghafari4–Reference Kim, Kim, Chae, Hwang, Lee and Lee10 Ectopic eruption of teeth into areas other than the oral cavity is thought to be due to an abnormal interaction between the oral epithelium and the underlying mesenchyme.Reference Goh9 Rhinosinusitis resulting from ectopic teeth in the maxillary sinusReference Di Felice and Lombardi7, Reference Goh9, Reference Buyukkurt, Tozoglu, Aras and Yolcu11 or in the floor of both nasal cavitiesReference Sokolov, Jecker and Roth12 has been reported, due to osteomeatal complex blockage by the teeth, and has been demonstrated clearly by CT scanning.Reference Jude, Horowitz and Loree13

This is the first case report to describe a frontal mucocele arising secondary to maxillary sinusitis caused by an ectopic maxillary tooth. It demonstrates the ease with which this patient's symptoms resolved following surgical removal of the aberrant ectopic tooth, thus avoiding an endoscopic sinus procedure. The case also highlights a more unusual cause of frontal mucocele.

  • • This is the first documented case of a frontal mucocele arising in association with maxillary sinusitis due to an ectopic maxillary sinus tooth

  • • The ectopic tooth was removed via a sub-labial approach, following which the maxillary sinusitis and the frontal mucocele resolved

References

1Gavioli, C, Grasso, DL, Carinci, F, Amoroso, C, Pastore, A. Mucoceles of the frontal sinus. Clinical and therapeutical considerations. Minerva Stomatol 2002;51:385–90Google ScholarPubMed
2Picavet, V, Jorissen, M. Risk factors for recurrence of paranasal sinus mucoceles after ESS. B-ENT 2005;1:31–7Google ScholarPubMed
3Khong, JJ, Malhotra, R, Wormald, PJ, Selva, D. Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement. Eye 2004;18:877–81Google Scholar
4Hasbini, AS, Hadi, U, Ghafari, J. Endoscopic removal of an ectopic third molar obstructing the osteomeatal complex. Ear Nose Throat J 2001;80:667–70Google Scholar
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6Bodner, L, Tovi, F, Bar-Ziv, J. Teeth in the maxillary sinus – imaging and management. J Laryngol Otol 1997;111:820–4Google Scholar
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8Elango, S, Palaniappan, SP. Ectopic tooth in the roof of the maxillary sinus. Ear Nose Throat J 1991;70:365–6Google Scholar
9Goh, YH. Ectopic eruption of maxillary molar tooth – an unusual cause of recurrent sinusitis. Singapore Med J 2001;42:80–1Google Scholar
10Kim, DH, Kim, JM, Chae, SW, Hwang, SJ, Lee, SH, Lee, HM. Endoscopic removal of an intranasal ectopic tooth. Int J Pediatr Otorhinolaryngol 2003;67:79–81CrossRefGoogle ScholarPubMed
11Buyukkurt, MC, Tozoglu, S, Aras, MH, Yolcu, U. Ectopic eruption of a maxillary third molar tooth in the maxillary sinus: a case report. J Contemp Dent Pract 2005;6:104–10Google Scholar
12Sokolov, M, Jecker, P, Roth, Y. Nasal teeth associated with rhinosinusitis. Rhinology 2004;42:167–70Google Scholar
13Jude, R, Horowitz, J, Loree, T. A case report. Ectopic molars that cause osteomeatal complex obstruction. J Am Dent Assoc 1995;126:1655–7Google Scholar
Figure 0

Fig. 1 Clinical photograph demonstrating a right frontal mucocele (arrow).

Figure 1

Fig. 2 Computed tomogram showing a bony defect in the floor of the right frontal sinus (arrow), through which the mucocele extended into the superomedial aspect of the right orbit.

Figure 2

Fig. 3 Computed tomogram demonstrating an ectopic tooth in the right maxillary antrum.