Abstract
<title>Abstract</title> <p>Introduction: Intranasal supernumerary teeth are a rare cause of unilateral nasal obstruction. Bilateral occurrence in a non-syndromic adult is exceptionally rare, with fewer than five cases reported in the literature. Computed tomography (CT) demonstrating enamel-level attenuation and internal dental architecture enables definitive noninvasive diagnosis. Case Report: A 47-year-old man presented with left-sided nasal obstruction and intermittent epistaxis. Endoscopy revealed a firm sessile mass on the left nasal floor. Non-contrast CT of the paranasal sinuses demonstrated bilateral supernumerary teeth — the left tooth measuring 8 × 4 mm projecting into the nasal cavity, and the right tooth measuring 15 × 6 mm entirely intra-alveolar. Both showed enamel-level attenuation of 1800–1900 Hounsfield units, identifiable pulp cavities, and well-defined crown morphology. No bony destruction was identified. The patient was referred for combined otorhinolaryngological and dental management. Conclusion Non-contrast CT with bone window reconstruction is the investigation of choice for intranasal ectopic teeth, demonstrating enamel-level attenuation and internal dental architecture that definitively distinguishes them from rhinoliths and osteomas. Multiplanar reconstruction is essential for surgical planning. Bilateral CT evaluation is important even when symptoms are unilateral.</p>