Mandibular fracture after removal of third molar. Report of five cases of a rare
complication
Constantinos MOUROUZIS, Dimosthenis IGOUMENAKIS, Georgios GKINIS, George RALLIS
Department of Oral and Maxillofacial Surgery, General Hospital of Attica “KAT”, Greece (Head Coordinator: Dr G. Rallis)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 1, 19-25
SUMMARY: A rare complication of the surgical removal of a third molar is the fracture of the mandible. A series of cases of such fractures is here presented. Material and method: It is retrospective study of cases treated at the OMFS dept of KAT Hospital. Results: The patients were 3 females and 2 males, with a mean age of 50.4 years. In all cases the fracture was located at the angle of the mandible and in two cases it was complicated with osteomyelitis. In four cases open reduction and internal fixation was undertaken and in one case intermaxillary fixation only. Following treatment, fracture healing without problem was achieved in all cases. Conclusions: Fracture of the mandible, as a complication of surgical removal of a third molar is an infrequent but severe situation. Neglected postextractive fractures have increased risk for development of osteomyelitis. When removing impacted third molars, the surgeon should implement an atraumatic technique, by removing as less bone as possible. In high risk cases precise instructions must be given to the patients and the significance of soft diet must be highlighted.
KEY WORDS: third molar, surgical removal, iatrogenic fracture, osteomyelitis
REFERENCES
Amler MH, Johnson PL, Salman I: Histological and histochemical investigation of human alveolar socket healing in undisturbed extraction wounds. J Am Dent Assoc. 61:33-44, 1960
Bodner L, Brennan PA, McLeod NM: Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 49: 567-572, 2011
Brauer HU: Unusual complications associated with third molar surgery: a systematic review. Quintessence Int. 40: 565-572, 2009
Gavriil S, Giamarelos G, Dendrinos Chr, Melakopoulos L, Sempepou I, Bosinakou M: Management of Mandibular Fractures. Report of 114 patients. Hellenic Arch Oral Maxillofac Surg. 4: 20-32. 2003
Iizuka T, Tanner S, Berthold H: Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 26: 338-343, 1997
Krimmel M, Reinert S: Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 58: 1110-1112, 2000
Libersa P, Roze D, Cachart T, Libersa JC: Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 60: 163-165, 2002
Pell GJ, Gregory T: Report on a ten –year study of a tooth division technique for the removal of impacted teeth. Am J Orthod. 28: 660-666, 1942
Perry PA, Goldberg MH: Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 58: 858-861, 2000
Schuknecht BF, Carls FR, Valavanis A, Sailer HF: Mandibular osteomyelitis: evaluation and staging in 18 patients, using magnetic resonace imaging, computed tomography and conventional radiographs. J Craniomaxillofac Surg. 25: 24-33, 1997
Theologie-Lygidakis N, Samaras C, Skondras A, Iatrou I: Contemporary treatment of iatrogenic mandibular fractures. Odontostomatological Progress 51: 238-243, 1997
Wagner KW, Otten JE, Schoen R, Schmelzeisen R: Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 34:722-726, 2005
Wagner KW, Shoen R, Wongchuensoontorn C, Schmelzeisen R: Complicated late mandibular fracture following third molar removal. Quintessence Int 38: 63-65, 2007
Department of Oral and Maxillofacial Surgery, General Hospital of Attica “KAT”, Greece (Head Coordinator: Dr G. Rallis)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 1, 19-25
SUMMARY: A rare complication of the surgical removal of a third molar is the fracture of the mandible. A series of cases of such fractures is here presented. Material and method: It is retrospective study of cases treated at the OMFS dept of KAT Hospital. Results: The patients were 3 females and 2 males, with a mean age of 50.4 years. In all cases the fracture was located at the angle of the mandible and in two cases it was complicated with osteomyelitis. In four cases open reduction and internal fixation was undertaken and in one case intermaxillary fixation only. Following treatment, fracture healing without problem was achieved in all cases. Conclusions: Fracture of the mandible, as a complication of surgical removal of a third molar is an infrequent but severe situation. Neglected postextractive fractures have increased risk for development of osteomyelitis. When removing impacted third molars, the surgeon should implement an atraumatic technique, by removing as less bone as possible. In high risk cases precise instructions must be given to the patients and the significance of soft diet must be highlighted.
KEY WORDS: third molar, surgical removal, iatrogenic fracture, osteomyelitis
REFERENCES
Amler MH, Johnson PL, Salman I: Histological and histochemical investigation of human alveolar socket healing in undisturbed extraction wounds. J Am Dent Assoc. 61:33-44, 1960
Bodner L, Brennan PA, McLeod NM: Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 49: 567-572, 2011
Brauer HU: Unusual complications associated with third molar surgery: a systematic review. Quintessence Int. 40: 565-572, 2009
Gavriil S, Giamarelos G, Dendrinos Chr, Melakopoulos L, Sempepou I, Bosinakou M: Management of Mandibular Fractures. Report of 114 patients. Hellenic Arch Oral Maxillofac Surg. 4: 20-32. 2003
Iizuka T, Tanner S, Berthold H: Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 26: 338-343, 1997
Krimmel M, Reinert S: Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 58: 1110-1112, 2000
Libersa P, Roze D, Cachart T, Libersa JC: Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 60: 163-165, 2002
Pell GJ, Gregory T: Report on a ten –year study of a tooth division technique for the removal of impacted teeth. Am J Orthod. 28: 660-666, 1942
Perry PA, Goldberg MH: Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 58: 858-861, 2000
Schuknecht BF, Carls FR, Valavanis A, Sailer HF: Mandibular osteomyelitis: evaluation and staging in 18 patients, using magnetic resonace imaging, computed tomography and conventional radiographs. J Craniomaxillofac Surg. 25: 24-33, 1997
Theologie-Lygidakis N, Samaras C, Skondras A, Iatrou I: Contemporary treatment of iatrogenic mandibular fractures. Odontostomatological Progress 51: 238-243, 1997
Wagner KW, Otten JE, Schoen R, Schmelzeisen R: Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 34:722-726, 2005
Wagner KW, Shoen R, Wongchuensoontorn C, Schmelzeisen R: Complicated late mandibular fracture following third molar removal. Quintessence Int 38: 63-65, 2007
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