The presence of a tooth in the nasal cavity is rare, often arising from developmental defects in neural crest derivatives or disturbances such as a complete cleft lip and palate. It occurs in about 0.48% of complete cleft lip and palate cases.1 This report outlines the conservative management of an intranasal tooth in a 13-year-old girl, contrasting with previous cases managed under general anaesthesia.2,3

The patient, who had a history of left cleft lip and palate, underwent surgical correction of the cleft lip at one and a half months and palatal correction at one and a half years. She presented at our dental outpatient department with a mobile tooth in her left nostril, first noticed a few years prior but reported discomfort only recently as it became mobile.

Clinical examination showed a repaired cleft lip and palate with an oro-nasal fistula and revealed that the left upper lateral incisor was positioned at the floor of the left nostril, exhibiting grade III mobility. To evaluate the tooth's position and relationship with surrounding tissues, a cone-beam computed tomography (CBCT) scan was conducted, showing the tooth situated within the nasal mucosa with no bony adherence (Fig. 1).

Fig. 1
figure 1

Pre op images: (A) Pre-op intranasal tooth, (B) 3D volumetric view, (C) CBCT

Full size image

The patient was cooperative, and a conservative extraction was planned under local anaesthesia following basic blood work. On the surgery day, an infraorbital nerve block and local infiltration around the tooth were performed using 2% lidocaine with 1:80,000 adrenaline (Lignospan Special, Septodont). The ectopically erupted tooth was successfully extracted using bayonet forceps (Fig. 2). Post-extraction, a thick nasal pack was placed to control bleeding, and haemostasis was achieved within ten minutes. The patient was observed for an hour before discharge.

Fig. 2
figure 2

Extracted tooth

Full size image

The patient was advised against blowing her nose or gargling vigorously after meals. However, at midnight, the parents reported bleeding from the nostril, prompting a visit to the Accident & Emergency department. There, sterile haemocoagulase solution 0.2 cu (Botroclot) was applied to control the bleeding, and the child was discharged after complete haemostasis was achieved. A follow-up examination the next day confirmed the clot was still intact, and five days later, it fell off, with the area healing adequately.

This case features a conservative approach to managing an intranasal tooth while highlighting the importance of regular follow-ups for children with cleft lip and palate. Such monitoring, potentially on an annual basis, can facilitate early intervention to prevent complications associated with ectopic tooth eruption. Overall, this conservative management strategy can be beneficial, particularly in paediatric cases.