Odontogenic Cyst From an Ectopic Supernumerary Tooth Impacted in the Orbital Floor

Abstract

Objectives:Supernumerary dentition has been found to occur in various areas of the head and neck. Although they are commonly found along the dental arch, there are some instances of ectopic supernumerary teeth found elsewhere in the upper aero digestive tract. This case report details an impacted molar tooth in the orbital floor.Methodology:We present an unusual case of a 30-year-old male with a chief complaint of nasal obstruction. Clinically, it was manifested with an impacted molar in the orbital floor with associated bony expansion into the maxillary and ethmoid sinuses.Results:Radiographically, CT scan revealed a benign appearing expansile mass in the left maxilla, completely occupying the sinus and extending into the nose and expanding laterally into the cheek. There appeared to be a well-formed tricuspid tooth clearly visible at the top of this lesion protruding into the left orbit. The patient underwent endoscopic surgical removal, showed findings of an impacted tricuspid in the medial and inferior walls of the orbit. Histopathologic examination confirmed a large cyst lined by thick stratified squamous epithelium and embedded with dense fibrous connective tissue, consistent with an orthokeratinized odontogenic cyst. The medial orbital wall was decompressed, and his postoperative course was uneventful with no orbital complications. Ectopic supernumerary teeth are unusual findings, particularly in association with the orbit. They are frequently impacted and as such can lead to the development of cystic lesions. As with other odontogenic cysts, surgery is usually definitive. This case study demonstrates complete removal with endoscopic surgery.