Subperiosteal abscess: A postoperative complication after surgical extraction of impacted third molars. Report of a case
Pindaros-Georgios FOSKOLOS, Stephania HADJIPETROU, Anastassios I. MYLONAS, Nikolaos KOLOMVOS
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece (Head: Professor C. Perisanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 2, 77-83
SUMMARY: Subperiosteal abscess is a rare later complication after surgical extraction of impacted third molars, that occurs two weeks to one month postoperatively. The reported frequency of this complication is less than 10% of all types of postoperative complications arising after impacted third molar removal, and it is manifested as a swelling in the post-extraction socket area. The patient’s general health, quality of oral hygiene, third molar’s impaction level, and pre-existing local infection, are some of the major risk factors. This paper aims to present the management of a case of subperiosteal abscess after sur- gical extraction of an impacted third molar. The clinical signs and symptoms, the pathogenic mechanism, and the treatment protocol followed in dealing with this complication are discussed.
KEY WORDS: Subperiosteal abscess, impacted third molar, postoperative complications.
REFERENCES
Ahmed A, Mohamed F, Hattab K: Surgical extraction of impacted mandibular third molars: postoperative complications and their risk factors. JMJ, 9(4): 272 - 75, 2009
Arteagoitia I, Diez A, Barbier L, Santamaría G, Santamaría J: Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflamma- tory complications following impacted mandibular third molar ex- traction. Oral Surg Oral Med Oral Pathol Oral Radiol and En- dodont, 100 (1): 11 – 8, 2005
Blondeau F, Daniel NG: Extraction of impacted mandibular third mo- lars: postoperative complications and their risk factors. J Canadian Dental Association, 73 (4), 2007
Bouloux GF, Steed MB, Perciaccante VJ: Complications of third molar surgery. J Oral and Maxillofac Surg Clinics, 19 (1): 117 – 28, 2007 Brunello G, De Biagi M, Crepaldi G, Rodrigues FI, Sivolella S: An ob- servational cohort study on delayed-onset infections after
mandibular third-molar extractions. Int J Dent, 2017:1-5, 2017
Bui CH, Seldin EB, Dodson TB: Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg, 61(12): 1379 – 89, 2003
Chiapasco M, De Cicco L, Marrone G: Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol, 76 (4): 412 – 20, 1993
Cho H, Lynham AJ, Hsu E: Postoperative interventions to reduce in- flammatory complications after third molar surgery: review of the current evidence. Australian Dental Journal, 62 (4): 412 – 9, 2017 Chuang SK, Perrott DH, Susarla SM, Dodson TB: Risk factors for in- flammatory complications following third molar surgery in adults.
J Oral Maxillofac Surg, 66 (11): 2213 – 8, 2008
Deliverska EG, Petkova M: Complications after extraction of impacted third molars - literature review. J IMAB, 22 (3): 1202 – 11, 2016
De Oliveira Neto PJ, de Souza Maliska MC, Sawazaki R, Asprino L, de Moraes M, Moreira RW: Temporal abscess after third molar ex- traction in the mandible. J Oral Maxillofac Surg, 16 (1): 107 – 10, 2012
Figueiredo R, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C: Incidence and clinical features of delayed-onset infections after extraction of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol and Endodont, 99 (3): 265 – 9, 2005
Figueiredo R, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C: Delayed-onset infections after lower third molar extraction: a case-control study. J Oral Maxillofac Surg, 65 (1): 97 - 102, 2007 Figueiredo R, Valmaseda-Castellón E, Laskin DM, Berini–Aytés L, Gay– Escoda C: Treatment of Delayed-Onset Infections After Impacted Lower Third Molar Extraction. J Oral Maxillofac Surg, 66: 943 - 947, 2008
Figueiredo R, Valmaseda-Castellón E, Formoso-Senande MF, Berini- Aytés L, Gay-Escoda C: Delayed-onset infections after impacted lower third molar extraction: involved bacteria and sensitivity pro- files to commonly used antibiotics. Oral Surg Oral Med Oral Pathol Oral Radiol, 114 (1): 43 - 8, 2012
Freudlsperger C, Deiss T, Bodem J, Engel M, Hoffmann J: Influence of lower third molar anatomic position on postoperative inflamma- tory complications. J Oral Maxillofac Surg, 70 (6): 1280 - 5. 2012 Goldberg MH, Nemarich AN, Marco WP: Complications after mandibular third molar surgery: a statistical analysis of 500 con- secutive procedures in private practice. Journal of the American
Dental Association, 111 (2): 277 – 9, 1985
Isiordia-Espinoza MA, Aragon-Martinez OH, Martínez-Morales JF, Za- pata-Morales JR : Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg, 53 (9): 796 - 804, 2015
Kamolratanakul P, Jansisyanont P: A review of antibiotic prophylaxis protocols in oral and maxillofacial surgery. J Oral Maxillofac Surg, Medicine and Pathology, 11: 395 - 404, 2018
Miclotte I, Agbaje JO, Spaey Y, Legrand P, Politis C: Incidence and treatment of complications in patients who had third molars or other teeth extracted. Br J Oral Maxillofac Surg, 56 (5): 388 - 93, 2018
Momin M, Albright T, Leiken J, Miloro M, Markiewicz MR: Patient mor- bidity among residents extracting third molars: does experience matter ?. Oral Surg Oral Med Oral Pathol Oral Radiol, 125, 415 – 422, 2018
Monaco G, Cecchini S, Gatto MR, Pelliccioni GA: Delayed onset in- fections after lower third molar germectomy could be related to the space distal to the second molar. Int J Oral Maxillofac Surg, 46 (3): 373 - 8, 2017
Mowlem R: Osteomyelitis of the jaw. Journal of Royal Society Medi- cine, 38(8): 452-455, 1945
Poeschl PW, Eckel D, Poeschl E: Postoperative prophylactic antibiotic treatment in third molar surgery-A necessity ?. J Oral Maxillofac Surg, 62 (1): 3 - 8, 2004
Sane VD, Gadre KS, Chandan S, Halli R, Saddiwal R, Kadam P: Is post- operative antibiotic therapy justified for surgical removal of mandibular third molar? A comparative study. J Oral Maxillofac Surg, 13 (2): 189 - 94, 2014
Sigron GR, Pourmand PP, Mache B, Stadlinger B, Locher MC: The most common complications after wisdom-tooth removal: part 1: a ret- rospective study of 1,199 cases in the mandible. Swiss Dent J, 124 (10): 1042 - 1056, 2014
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece (Head: Professor C. Perisanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 2, 77-83
SUMMARY: Subperiosteal abscess is a rare later complication after surgical extraction of impacted third molars, that occurs two weeks to one month postoperatively. The reported frequency of this complication is less than 10% of all types of postoperative complications arising after impacted third molar removal, and it is manifested as a swelling in the post-extraction socket area. The patient’s general health, quality of oral hygiene, third molar’s impaction level, and pre-existing local infection, are some of the major risk factors. This paper aims to present the management of a case of subperiosteal abscess after sur- gical extraction of an impacted third molar. The clinical signs and symptoms, the pathogenic mechanism, and the treatment protocol followed in dealing with this complication are discussed.
KEY WORDS: Subperiosteal abscess, impacted third molar, postoperative complications.
REFERENCES
Ahmed A, Mohamed F, Hattab K: Surgical extraction of impacted mandibular third molars: postoperative complications and their risk factors. JMJ, 9(4): 272 - 75, 2009
Arteagoitia I, Diez A, Barbier L, Santamaría G, Santamaría J: Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflamma- tory complications following impacted mandibular third molar ex- traction. Oral Surg Oral Med Oral Pathol Oral Radiol and En- dodont, 100 (1): 11 – 8, 2005
Blondeau F, Daniel NG: Extraction of impacted mandibular third mo- lars: postoperative complications and their risk factors. J Canadian Dental Association, 73 (4), 2007
Bouloux GF, Steed MB, Perciaccante VJ: Complications of third molar surgery. J Oral and Maxillofac Surg Clinics, 19 (1): 117 – 28, 2007 Brunello G, De Biagi M, Crepaldi G, Rodrigues FI, Sivolella S: An ob- servational cohort study on delayed-onset infections after
mandibular third-molar extractions. Int J Dent, 2017:1-5, 2017
Bui CH, Seldin EB, Dodson TB: Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg, 61(12): 1379 – 89, 2003
Chiapasco M, De Cicco L, Marrone G: Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol, 76 (4): 412 – 20, 1993
Cho H, Lynham AJ, Hsu E: Postoperative interventions to reduce in- flammatory complications after third molar surgery: review of the current evidence. Australian Dental Journal, 62 (4): 412 – 9, 2017 Chuang SK, Perrott DH, Susarla SM, Dodson TB: Risk factors for in- flammatory complications following third molar surgery in adults.
J Oral Maxillofac Surg, 66 (11): 2213 – 8, 2008
Deliverska EG, Petkova M: Complications after extraction of impacted third molars - literature review. J IMAB, 22 (3): 1202 – 11, 2016
De Oliveira Neto PJ, de Souza Maliska MC, Sawazaki R, Asprino L, de Moraes M, Moreira RW: Temporal abscess after third molar ex- traction in the mandible. J Oral Maxillofac Surg, 16 (1): 107 – 10, 2012
Figueiredo R, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C: Incidence and clinical features of delayed-onset infections after extraction of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol and Endodont, 99 (3): 265 – 9, 2005
Figueiredo R, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C: Delayed-onset infections after lower third molar extraction: a case-control study. J Oral Maxillofac Surg, 65 (1): 97 - 102, 2007 Figueiredo R, Valmaseda-Castellón E, Laskin DM, Berini–Aytés L, Gay– Escoda C: Treatment of Delayed-Onset Infections After Impacted Lower Third Molar Extraction. J Oral Maxillofac Surg, 66: 943 - 947, 2008
Figueiredo R, Valmaseda-Castellón E, Formoso-Senande MF, Berini- Aytés L, Gay-Escoda C: Delayed-onset infections after impacted lower third molar extraction: involved bacteria and sensitivity pro- files to commonly used antibiotics. Oral Surg Oral Med Oral Pathol Oral Radiol, 114 (1): 43 - 8, 2012
Freudlsperger C, Deiss T, Bodem J, Engel M, Hoffmann J: Influence of lower third molar anatomic position on postoperative inflamma- tory complications. J Oral Maxillofac Surg, 70 (6): 1280 - 5. 2012 Goldberg MH, Nemarich AN, Marco WP: Complications after mandibular third molar surgery: a statistical analysis of 500 con- secutive procedures in private practice. Journal of the American
Dental Association, 111 (2): 277 – 9, 1985
Isiordia-Espinoza MA, Aragon-Martinez OH, Martínez-Morales JF, Za- pata-Morales JR : Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg, 53 (9): 796 - 804, 2015
Kamolratanakul P, Jansisyanont P: A review of antibiotic prophylaxis protocols in oral and maxillofacial surgery. J Oral Maxillofac Surg, Medicine and Pathology, 11: 395 - 404, 2018
Miclotte I, Agbaje JO, Spaey Y, Legrand P, Politis C: Incidence and treatment of complications in patients who had third molars or other teeth extracted. Br J Oral Maxillofac Surg, 56 (5): 388 - 93, 2018
Momin M, Albright T, Leiken J, Miloro M, Markiewicz MR: Patient mor- bidity among residents extracting third molars: does experience matter ?. Oral Surg Oral Med Oral Pathol Oral Radiol, 125, 415 – 422, 2018
Monaco G, Cecchini S, Gatto MR, Pelliccioni GA: Delayed onset in- fections after lower third molar germectomy could be related to the space distal to the second molar. Int J Oral Maxillofac Surg, 46 (3): 373 - 8, 2017
Mowlem R: Osteomyelitis of the jaw. Journal of Royal Society Medi- cine, 38(8): 452-455, 1945
Poeschl PW, Eckel D, Poeschl E: Postoperative prophylactic antibiotic treatment in third molar surgery-A necessity ?. J Oral Maxillofac Surg, 62 (1): 3 - 8, 2004
Sane VD, Gadre KS, Chandan S, Halli R, Saddiwal R, Kadam P: Is post- operative antibiotic therapy justified for surgical removal of mandibular third molar? A comparative study. J Oral Maxillofac Surg, 13 (2): 189 - 94, 2014
Sigron GR, Pourmand PP, Mache B, Stadlinger B, Locher MC: The most common complications after wisdom-tooth removal: part 1: a ret- rospective study of 1,199 cases in the mandible. Swiss Dent J, 124 (10): 1042 - 1056, 2014
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