Daily Radiology Case

Explanation

Ectopic supernumerary teeth are a rare incidental finding, with only a limited number of cases reported worldwide. These teeth can arise anywhere throughout the midface and may present with symptoms such as epistaxis, nasal obstruction, foul smelling rhinorrhea, headache, facial pain, or recurrent sinusitis. In many cases the cause is unknown, but associations include prior facial trauma, cleft palate, and conditions such as Gardner’s syndrome. On imaging, the key is recognizing something that simply does not belong. In this case, there is a well defined radiopaque structure originating near the nasopalatine foramen and extending into the left nasal cavity. Normally, the nasal cavity should contain air density, not a dense, structured object. When you see a sharply defined radiopaque structure in that space, especially one with crown and root morphology, that should immediately raise suspicion for an ectopic dental structure.

Source: Sharma S, Supernumerary ectopic tooth. Case study, Radiopaedia.org (Accessed on 14 Feb 2026) https://doi.org/10.53347/rID-157245

Hints

• A 35-year-old male presents to the emergency department with complaints of a generalized headache
• He reports a history of MMA fighting with prior facial trauma
• On HEENT exam, mild nasal obstruction and foul-smelling rhinorrhea are noted
• Initial imaging lead to CT, which demonstrates an unusual radiopaque structure on axial and coronal views within the maxilla
• Closer inspection reveals the structure lies superior to the dental arch and demonstrates morphology distinct from the surrounding bones
• An additional distinct tooth-like structure is identified outside the expected anatomical alignment of the dentition