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Neuroradiology Case of the Week

Case 316

Adam J. Weller, MSIV

Clinical Presentation: An 18-year-old female with trauma to face and neck, now complains of left jaw pain and swelling.

Imaging Findings: Panorex and PA views of the mandible show no evidence of fracture-dislocation. CT scan of orbits and maxillofacial region demonstrate no acute injury. Impacted right maxillary canine tooth is visualized.

Diagnosis: Impacted right maxillary canine

Discussion: An impacted tooth is a tooth that does not erupt into its normally functioning position; therefore, these teeth are considered pathologic and require treatment. An impacted tooth is one of the most common disorders of eruption involving the teeth. Tooth impaction is thought to be due, in part, to a lack of space in the jaws, which is exacerbated in some cases by the early loss of deciduous teeth. Endocrine disorders like hypothyroidism and hypopituitarism or genetic abnormalities like Downs Syndrome are also known to cause impaction. Local factors such as deciduous tooth retention, malposed tooth germs, arch length deficiency, supernumerary teeth, odontogenic tumors, abnormal eruption path, and cleft lip and palate are commonly the cause of permanent tooth retention. While the majority of impacted teeth are third molars, the second most common impacted tooth is the maxillary canine such as in this case. Virtually all teeth can be impacted, however impaction of the first molars and incisors are relatively uncommon.
     The clinical problems associated with impacted permanent teeth include malocclusion, loss of arch length, migration or loss of neighboring teeth, periodontal disease, root resorption of adjacent teeth, resorption of the impacted tooth, dentigerous cysts or odontogenic tumors, and pericoronitis. The usual treatment of an impacted tooth is removal, especially if it is a third molar, however with teeth other than third molars other options might be better. These treatments may include exposure, uprighting, transplantation, or removal.

References:

1. Miloro M. Peterson's Principles of Oral and Maxillofacial Surgery, 2nd Edition, 2004, Canada, BC Decker Inc.
2. Grainge & Atkinson's Diagnostic Radiology: A Textbook of Medical Imaging, 4th Edition, 2001, Orlando, Church Livingston Inc.