Obstructive sleep apnoea (OSA) is a common medical condition with significant medical consequences. The prevalence of this disease in the United States is currently estimated to be between 5 and 10% [
A 74-year-old man was referred to the maxillofacial department of our hospital with a long history of chronic episodic facial pain and discomfort arising from the left maxillary sinus. The pain appeared to be related only to the cold air emanating from his full-face mask CPAP interface he used for the treatment of his moderate OSA. His medical history was otherwise unremarkable; in particular there was no history of facial trauma or regional infection and swelling.
Examination revealed mild maxillary sinus pain elicited by percussion in the retromolar area of the left upper quadrant, distal to the only visible molar, which was reactive to cold and not painful to percussion. Nasal endoscopy revealed no purulent discharge.
An orthopantomogram (OPG) was requested as an overview of the state of the patients’ dentition (Figure
Panoramic radiograph revealing superimposition of left upper third molar and left maxillary sinus (red arrow).
Sagittal view of the CT-scanner showing hyperdense material in the floor of the left maxillary sinus consistent with an ectopic third molar.
After informed consent from the patient had been obtained, we planned an elective procedure under local anesthetic. A mucoperiosteal flap was raised in the region of the permanent first, second, and third molar and extended to the left maxillary tuberosity (Figure
Vestibular incision extending to the left maxillary tuberosity (a), creation of a bony window in the anterior wall of the left maxillary sinus (b), and ectopic third molar showing complete crown but incomplete root formation (c).
Postoperatively, the patient made an uneventful recovery and there was no recurrence of his symptoms in a 3-month follow-up period.
The aetiology of facial pain related to CPAP use can be classified as pressure related or airflow related causes.
Dental or periodontal pain for instance is mainly explained by direct pressure of the device on the gums. This is the case in 15 to 20% of patients treated with CPAP [
On the other hand, nasopharyngeal symptoms, like nasal obstruction, rhinorrhoea, sneezing, blocked ears, or excessive mucus, are present in 15 to 65% of the cases. These are more frequent in patients with preexisting problems [
The approach to facial pain in CPAP users should not be limited to typical causes of CPAP device related problems. It should encompass classical causes of facial pain such as dentoalveolar pathology, sinusitis, temporomandibular joint disorders, and neuropathic pain [
To date, only 35 cases of ectopic teeth erupting in the maxillary sinus have been reported in the English literature [
The eruption of a tooth in nondentate areas is rare, although various cases of teeth erupting in the nasal septum [
Ectopic tooth formation may happen due to an abnormal interaction between oral epithelium and the underlying mesenchyma during odontogenesis, from pathological processes (cleft palate, infection, bone hyperdensity, and genetic factors) or from trauma [
Diagnosis and treatment planning are best made by CT scanner [
Complete removal of diseased tissue is thought to be mandatory as certain diseases such as cysts or malignancies may coexist with ectopic molars [
The use of CPAP is associated with a reduction in daytime sleepiness and the improvement of quality of life [
The authors declare that there is no conflict of interests regarding the publication of this paper.