Clinical Report: Rhinolith may hide intranasal ectopic tooth

Overview

A 45-year-old man with persistent foul-smelling unilateral nasal discharge and intermittent epistaxis was found to have an ectopic tooth projecting into the right nasal cavity, surrounded by calcifications consistent with a rhinolith. CT demonstrated tooth-like anatomy, including a central pulp cavity, without destructive changes. Endoscopic removal was followed by an uneventful recovery and complete resolution of symptoms.

Background

Intranasal ectopic teeth are uncommon and may be asymptomatic or cause nonspecific sinonasal symptoms. In a systematic review cited in the report, nasal obstruction occurred in 48% of cases, while rhinorrhea, facial pain, and epistaxis each occurred in 22%. Calcified intranasal lesions can resemble one another, making recognition of tooth morphology relevant to diagnosis. The report notes that CT characterizes lesion location, morphology, and relationships to surrounding structures, while endoscopy allows direct visualization and supports surgical management.

Data Highlights

Key Findings

• The patient reported 6 months of continuous, foul-smelling right-sided nasal discharge and intermittent mild epistaxis.
• Endoscopy showed a hard, irregular white mass on the floor of the right nasal cavity, partially surrounded by calcified material.
• Noncontrast CT showed a hyperdense tooth-like structure arising from the hard palate, with attenuation similar to enamel and dentin and a central low-density pulp cavity.
• Curvilinear calcifications around the tooth-like structure were consistent with rhinolith formation; CT showed no adjacent bony destruction, cortical erosion, aggressive periosteal reaction, or extension into neighboring structures.
• Endoscopic transnasal removal was uncomplicated; at follow-up, the nasal cavity appeared healthy and the patient was symptom-free, with resolution of obstruction and discharge.

Clinical Implications

For a focal calcified intranasal lesion, the report describes CT assessment of tooth morphology and surrounding structures alongside endoscopic visualization. The authors note that asymptomatic ectopic intranasal teeth may be managed conservatively with regular observation and follow-up; in this symptomatic case, endoscopic removal was followed by symptom resolution.

Conclusion

This case describes an intranasal ectopic tooth associated with rhinolith formation, diagnosed by its characteristic CT morphology and treated with endoscopic removal. The patient had an uneventful postoperative course and complete resolution of reported symptoms.

Related Resources & Content

1. Kunwar B, et al., Radiology Case Reports, year not provided — Rhinolith may hide intranasal ectopic tooth
2. American College of Radiology, ACR Appropriateness Criteria — Sinonasal Disease, narrative page last updated 2025
3. MDSpire News — Nasal Tumor Misdiagnosed as Carcinoma
4. Frontiers in Immunology — Tertiary lymphoid formations in chronic rhinosinusitis with nasal polyps: structural arrangement, pathological roles, and their relevance to surgical approaches and biologic treatment
5. Clinical Rheumatology — Nasal Bone Erosion Associated with Gouty Tophus Formation
6. Anatomical Study of Parathyroid, Thyroid, and Recurrent Laryngeal Nerve in the Indian Rhinoceros (Rhinoceros unicornis)
7. Intranasal ectopic tooth: An unusual diagnostic finding with review of literature
8. American College of Radiology ACR Appropriateness Criteria® Sinonasal Disease
9. Intranasal ectopic tooth: An unusual diagnostic finding with review of literature - PMC
10. American College of Radiology ACR Appropriateness Criteria® Sinonasal Disease