Severe nasal congestion, is it because "teeth" have "grown" into the nasal cavity?

Mr. Wang (pseudonym) from Changsha never imagined that the nasal congestion that had troubled him for half a year was not caused by a cold or rhinitis, but by a dentigerous cyst "growing" into the nasal cavity!

Mr. Wang, 25, has always felt a stuffy nose on the right side for the past six months. He was very puzzled: he did not have cold symptoms such as fever, runny nose, headache, sore throat, etc., nor had he suffered from rhinitis, but he always had a stuffy nose for no reason; in the past two months, the right nasal cavity was completely blocked and unable to breathe. He had to open his mouth to breathe when sleeping, and he always felt some swelling and pain near his nose on the right side of his face; on Sunday morning, his careful girlfriend discovered that Mr. Wang's left and right cheeks were somewhat asymmetrical, so she urged him to come to the ENT department of Changsha Third Hospital for treatment.

The right side is the affected side, and it can be seen that the right cheek is more prominent than the left side.

The red circle shows the mass in the sinus, and the yellow circle shows the shadow of the tooth in the mass

After a sinus CT scan and nasal endoscopy, it was found that a large cyst occupied Mr. Wang's right paranasal sinus and protruded into the nasal cavity and cheek, resulting in a lack of airflow in the right nasal cavity, causing Mr. Wang to have nasal congestion and facial deformation. The mass was still expanding and growing around, causing him to feel bloated and painful. What was even more surprising was that at the bottom of the mass, a tooth protruding into the sinus could be seen!

Xu Juan, the attending ENT physician who received the patient, told Mr. Wang that he had a "tennis ball"-sized lump in his sinus, and the culprit of the lump was actually a tooth!

"This is the first time I've heard that teeth can grow into the nose! Can this be cured?" Mr. Wang couldn't help but worry.

Yang Ming, deputy chief physician of the Department of Otolaryngology at Changsha Third Hospital, explained that Mr. Wang's condition is called maxillary sinus dentigerous cyst, a benign tumor that occurs after the formation of the crown or root of the tooth, and is formed by fluid exudation between the residual enamel epithelium and the crown. The site of dentigerous cyst is related to age: patients under 10 years old are mostly located in the mandibular premolars, patients aged 10 to 20 years are mostly located in the maxillary permanent canines, mandibular third molars and mandibular second premolars, and patients over 20 years old are mostly located in the mandibular third molars.

Mr. Wang's disease site is located in the maxillary bone. As the cyst continues to grow, it protrudes into the maxillary sinus, squeezes the surrounding structures, and grows forward, causing the right cheek to bulge significantly, higher than the left side; the cyst grows to the left and protrudes into the nasal cavity, causing the normal structure of the nasal cavity to deform and deviate to the left as a whole. The right nasal passage is completely blocked and cannot be ventilated. If not treated in time, the cyst will further grow and may protrude upward into the eye socket, causing serious consequences such as double vision and decreased vision.

Since most of Mr. Wang's cysts were located in the nasal cavity and sinuses, Yang Ming led the ENT team to perform surgical resection under nasal endoscopy. All surgical instruments entered and exited through the natural cavity of the nostrils, and there were no wounds in the oral and maxillofacial area.

On the second day after the operation, Mr. Wang was able to walk and take care of himself. He happily told the medical staff: "The operation did not leave any wounds on my face, the swelling and pain disappeared, my nasal cavity is very unobstructed, and I don't need to open my mouth to breathe at night. I haven't had a good night's sleep for several months, and now I feel much more relaxed!" Three days later, Mr. Wang was successfully discharged from the hospital and returned to his normal social life and work.

The peak age of onset of dentigerous cyst is between 10 and 39 years old. Yang Ming reminded that if citizens have missing teeth or jaw bulging, they should go to the hospital for imaging examination in time to detect the presence of dentigerous cyst early and avoid excessive expansion of dentigerous cyst over time, which will increase the difficulty of surgery and treatment.

After determining the location of the cyst and confirming that it is a tooth-containing cyst, the doctor will develop an appropriate surgical plan based on the patient's condition: for very young and weak infants, a window decompression surgery can be performed, and a second-stage scaling can be performed after the cyst fluid is drained and the teeth have erupted; for other groups of people, cyst scaling surgery is the most commonly used treatment method in clinical practice, which is to completely scrape off the cyst wall under general anesthesia and remove the affected teeth in the cyst to cure the lesion and allow the bones to recover as soon as possible.