A young man from India, aged 16, experienced a swelling on his left upper eyelid. Doctors eventually determined that the problem stemmed from a tooth that had emerged in an improper position. The case report appeared in the journal Ophthalmology, where it was subsequently covered by Live Science.
A few months passed between when the boy first spotted the swelling and when he eventually sought medical care, and the swelling was not painful. About a month after the swelling appeared, he observed two pointed, white projections emerging from the skin above his eye. After that, he made his way to a hospital.
Doctors Wondered What the Projections Were
The report was co-authored by Dr. Meghana Tanwar, who serves as a medical consultant at the Aravind Eye Hospital in India. In an email to Live Science, she said the shape of the growths pointed toward teeth as a possibility.
The medical team weighed other possibilities as well. They speculated that the points could be linked to a teratoma, a rare kind of tumor containing several kinds of tissue, such as bone and tooth tissue. The projections were also considered a possible foreign body within the eyelid.
A CT scan was performed for a closer examination, and it showed that the projections were part of a tooth.
The Tooth in the Upper Eye Socket
The position of a solitary tooth within the upper eye socket was plainly visible, according to Tanwar. The term “Superior orbit”, which means the top part of the eye’s enclosure, identifies the location where the tooth had pushed through into the narrow gap between the boy’s eyelid and his eyebrow.
When a tooth grows out of its usual spot inside the mouth, it is called an ectopic tooth. That term covers any tooth that shows up in an atypical position during eruption. One common example is the first permanent molar, which in roughly 2% to 6% of people will emerge “out of place”. This particular tooth was located far from the oral cavity, however, since it sat entirely outside the dental arch rather than merely within it.
Such a situation is far rarer.
A mature canine tooth was taken out of the patient’s eyelid through surgery. The doctors found no signs that it came from a teratoma. Imaging failed to turn up any other ectopic teeth, which means it is unlikely the patient has more than one, according to Tanwar.
A First of Its Kind
According to Tanwar, this is the first and only case of an ectopic tooth found in the upper part of the eye socket. Before now, such teeth have been documented in the nasal cavity and beneath the eye, she pointed out.
MedPage Today reports that these markers have turned up in several places on the face, including the nostrils, chin, and the maxillary sinus, which sits within the cheekbone. “This was a first not just for us but the world over,” Tanwar commented on the case. “We were very surprised by it.”
This particular instance is not the first time an ectopic tooth has appeared in medical writing, yet its position sets it apart from other recorded cases.
The Previous Case Tanwar Saw
Before this case, Tanwar had already seen a tooth resting at the base of the eye socket in another patient. That tooth belonged to a rare kind of growth known as an odontogenic choristoma.
The exact reason behind the teen’s ectopic tooth was not determined. Researchers have suggested that such teeth typically develop in an improper position because of issues like developmental disorders, physical injury, infection or genetic traits.
Where Else Ectopic Teeth Have Turned Up
Other reports from medical studies describe teeth developing in unusual locations throughout the body, and here is a short summary of the sites where they have turned up.
- The nasal cavity
- The bottom of the orbit, under the eye
- The nostrils
- The chin
- The maxillary sinus, inside the cheekbone
None of these places had anything to do with the upper eye socket before, but each one stands apart on its own.
The Case Report
The tooth was taken out by the medical team, and no further ectopic teeth appeared on the imaging scans. The paper, titled “Ectopic canine tooth in the superior orbit,” came out in Ophthalmology, with authors Tanwar, Sharma and Kim.
This unusual instance marks a first for the medical record, and the physicians involved expressed great surprise at its occurrence.
For more intriguing medical cases, check out the Diagnostic Dilemma archives.
Source material: “Weird spikes poking through a teen's eyelid turned out to be a wayward tooth,” Live Science.
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