A 16-year-old boy in India recently had a mature canine tooth removed from an unusual location: the superior orbit of his left eye between his eyelid and eyebrow.
The case, published in Ophthalmology, is apparently the first documented report of an ectopic tooth in that part of the eye socket, although teeth have sprouted in plenty of unexpected parts of the face, reports MedPage Today.
The boy underwent surgery to remove the tooth and recovered without complications, said Meghana Tanwar, DO, DNB, of Aravind Eye Hospital in Madurai, India.
She said the patient had noticed a swelling on his left upper eyelid for a couple of months, which was painless and was not troubling him in any way until about a month before presentation, when he noticed two sharp, whitish projections protruding.
The condition caused no pain, only cosmetic concerns.
“People started asking what it was,” she noted. “His parents were concerned about a possible tumour and if this could affect his vision.”
After investigating, clinicians detected fullness in the left upper eyelid and two white conical projections, according to Tanwar. “They had a fairly smooth surface and were hard on palpation, suggestive of a tooth,” she said.
The differential diagnosis included a teratoma, bone, or even a foreign body, but a CT scan pinpointed the diagnosis.
“The structure of a lone tooth in the superior orbit was quite obvious,” Tanwar said.
By definition, ectopic teeth erupt in abnormal locations. As Tanwar noted, teeth have grown in the chin, palate, nasal cavity and inside the maxillary sinus.
In one notable case, an ectopic tooth was found inside the nostril of a 38-year-old man who’d suffered breathing problems for years.
Ectopic teeth have been reported in the eye orbit too, she said, but typically in the bottom part of the eye socket, known as the orbital floor.
A 2023 review offered several risk factors for ectopic teeth, such as “developmental disorders, trauma, infection, pathological disorders, and genetic factors,” or “even developmental atavism”, an evolutionary “throwback”.
In the current case, the patient’s ectopic tooth wasn’t harmful, at least for the moment. “It mainly posed a cosmetic rather than functional problem for our patient, as it was not impinging on any other structures in the orbit,” Tanwar said.
“But if it migrated closer to any of the orbital structures, such as muscle, eye, nerve, or vessels, it could have had functional issues due to the mechanical compression of these structures.”
The tooth was removed in a procedure under general anaesthesia after consultation with a maxilla-facial surgeon.
“Meticulous dissection was done to remove the entire tooth along with its immediate surrounding tissue without causing damage to normal functional tissue,” Tanwar said. The surgical procedure took about 20 minutes, and the wound had healed well at the two-week postoperative visit.
The patient had a minimal scar and no problems over a six-month follow-up.
Tanwar said that the team had previous experience on this front, with the excision of a rare tumour-like growth known as odontogenic choristoma that contained a tooth.
A choristoma refers to normal tissue that appears in an abnormal location; an odontogenic choristoma includes dental tissue.
The tissue was removed from the floor of the eye orbit of a seven-year-old girl who had had the growth since birth, with the assistance of a maxillofacial surgeon.
MedPage Today article – Teen Boy Grows a Tooth Between Eyelid and Eyebrow (Open access)
See more from MedicalBrief archives:
Vision restored after rare ‘tooth-in-eye’ surgery