A 16-year-old boy had a tooth found near his eye. How did it get there?

It all started with a small swelling near the left eye that didn't cause the teenager any pain. For about a month, he didn't seek medical attention. But when two hard, whitish tips began to protrude between his upper eyelid and eyebrow, the boy was taken to the hospital.

After examination, it was revealed that a fully formed canine — a tooth normally located third from the midline of the dental arch — was present in the orbital region. Doctors removed it.

Such cases in medicine are called ectopic teeth. This is a rare anomaly where a tooth forms or erupts in an abnormal location. Most often, such teeth are found in the maxillary sinus — a cavity behind the cheekbone. But doctors have also discovered them in the nose, palate, chin, temporomandibular joint, and even in the eye socket region.

These can be ordinary milk teeth or permanent teeth, as well as supernumerary teeth, which a person should not normally have.

A review of 61 cases described in medical literature showed that ectopic teeth can remain unnoticed for years. In some cases, they cause pain, swelling, headaches, or difficulty opening the mouth. For example, a tooth grown in the nasal cavity can cause nasal congestion, discharge, and nosebleeds.

How a tooth can end up near the eye

But how can a tooth even end up in such an unusual place as the eye socket? The answer lies in the stages of human intrauterine development.

A human face forms from several groups of cells and tissues that gradually move and connect. The correct interaction of these determines tooth development. If a malfunction occurs at this stage, a tooth can begin to form in an improper place, sometimes even far from the oral cavity.

However, congenital developmental anomalies are not the only possible cause. Injuries, dental interventions, cysts, and tumors can also lead to the appearance of ectopic teeth.

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In some cases, the presence of several extra teeth may indicate a hereditary disease. For example, in a rare genetic disease like cleidocranial dysplasia, bone and tooth development is impaired.

But in the case of the Indian teenager, doctors found no past injuries and were unable to determine why the tooth grew near his eye.

Does such a tooth always need to be removed?

Not all ectopic teeth require removal. If the tooth doesn't cause problems, doctors may simply monitor its condition. However, if it causes inflammation, impedes breathing, damages adjacent tissues, or is associated with cyst formation, surgery may be necessary. The decision also depends on the exact location of the tooth.

Before removal, medics use computed tomography to precisely determine the tooth's location and ascertain how close it is to nerves, blood vessels, and other vital structures.

The complexity of the operation depends on where the tooth grew. Sometimes, a simple extraction is sufficient, while in other cases, more complex surgical intervention is required.

For example, teeth found in the nose or nasal sinuses can often be removed using an endoscope — a thin tube with a camera and surgical instruments. It is inserted through the nostrils, allowing for removal without large incisions. One scientific review described 27 cases of such operations.

After an ectopic tooth is removed, a new one does not grow in its place. However, if a person has one extra tooth, there may be others, so doctors sometimes conduct additional examinations to find them. Isolated cases have been described in medical literature where another extra tooth formed in the same area after removal. However, this happens extremely rarely.

In the Indian teenager, no other teeth were found in unusual places. The case remained a rare anomaly, the exact cause of which doctors could not ascertain.

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