Endoscopic Endonasal Removal of an Intranasal Mesiodens: Importance of Three-Dimensional Evaluation for Approach Selection.

Although mesiodens is a frequently encountered supernumerary tooth, its complete migration into the nasal cavity is a rare clinical finding that can lead to various nasal symptoms. This report describes a case of an intranasal mesiodens that had fully migrated out of the maxillary bone and was embedded within the nasal mucosa without any osseous contact. Based on 3-dimensional radiographic evaluation, a prophylactic endoscopic endonasal approach was selected for removal. Under endoscopic visualization, the tooth was identified as a submucosal bulge and successfully extracted through a limited mucosal incision. The procedure was completed with minimal morbidity and did not require nasal packing. The patient showed favorable healing during the follow-up period without complications. This case demonstrates that for a fully migrated intranasal mesiodens without bony attachment, the endoscopic ensonasal approach is a simple, effective, and minimally invasive treatment option that provides direct visualization and excellent clinical outcomes.