Intranasal teeth: a narrative review of clinical features, diagnosis and management.
TL;DR
The clinical presentation is characterised and patient-level evidence relevant to imaging, operative planning and multidisciplinary management is synthesised and case-based evidence does not support comparative claims between approaches.
Abstract
Background Intranasal teeth are rare ectopic teeth situated wholly or partly within the nasal cavity. Because the evidence is dominated by case reports and terminology and anatomical boundaries vary across reports, diagnostic assessment and management have not been standardised. This review characterises the clinical presentation and synthesises patient-level evidence relevant to imaging, operative planning and multidisciplinary management. Methods We conducted a structured narrative review of PubMed, Embase, Web of Science and Scopus, supplemented by citation searching. Reports were eligible when a tooth entered or projected into the nasal cavity; teeth confined to a paranasal sinus without nasal-cavity involvement were excluded from the dataset. The included reports were critically appraised using the appropriate JBI checklist for case reports or case series. Results The dataset comprised 139 articles and 170 patient records. Age was reported for 169 patients (median 24.0 years, range 1.67-78), and sex for 169, of whom 107 (63.3%) were male. Supernumerary teeth were reported in 121 records (71.2%), and nasal-floor involvement in 135 (79.4%). The most frequently reported manifestations were nasal obstruction (n = 94), rhinorrhoea or purulent discharge (n = 73), mass or foreign-body sensation (n = 50), epistaxis (n = 46), and pain (n = 44). Any imaging was documented in 166 records (97.6%), including CT, CBCT or MSCT in 117 (68.8%). Removal or direct extraction was performed in 157 records (92.4%). Critical appraisal identified limitations in adverse-event reporting and post-treatment outcome reporting. Conclusions CT or CBCT interpreted with nasal endoscopy and oral examination provides the basis for confirming tooth identity, defining three-dimensional anatomy and selecting operative access. Endoscopic transnasal removal is the predominant published approach, whereas deeply embedded nasal-floor or nasal-maxillary-junction teeth may require oral or combined access. Management should be individualised according to symptoms, anatomical depth, procedural risk and the feasibility of surveillance. The case-based evidence does not support comparative claims between approaches.