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Eid MK, Sakka S, El-Badrawy A, Yousef EAS. Surgical retrieval of displaced mandibular third molars: A five-year experience with 16 cases. Curr Probl Surg 2024; 61:101528. [PMID: 39098328 DOI: 10.1016/j.cpsurg.2024.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 05/28/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Mohamed Kamal Eid
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Salah Sakka
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia.
| | - Adel El-Badrawy
- Department of Radiology, Faculty of Medicine, Mansoura University, Mansoura Egypt
| | - Eman Abdel Salam Yousef
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt; Faculty of Dentistry, Horus University, New Damietta, Egypt
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Nadeem A, Vohra LI, Ahsan A, Mushahid H, Tariq R, Rizwan M, Gul M, Raufi N. A rare case of mandibular third molar displaced into submandibular space: A complication of mandibular third molar extraction. Clin Case Rep 2023; 11:e8101. [PMID: 37867537 PMCID: PMC10587654 DOI: 10.1002/ccr3.8101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Key Clinical Message Accidental displacement of mandibular third molars or their roots into neighboring anatomical spaces, notably the submandibular region, during extraction, is a rare but significant complication. Comprehensive preoperative assessment, meticulous surgical techniques, and precise radiographic imaging play pivotal roles in successful management. Adhering to established protocols is imperative to mitigate potential complications and ensure optimal outcomes. Abstract In this report, we emphasize the critical importance of comprehensive preoperative preparation to tailor surgical approaches and techniques in accordance with recognized surgical principles. Oral and maxillofacial surgery often involves the extraction of impacted lower third molars, a common surgical procedure. However, this procedure can present potential complications such as hemorrhage, tissue damage, infection, alveolar osteitis, paresthesia, and mandible dislocation. Unintentional displacement of a mandibular third molar or its root fragments into adjacent anatomical areas, such as the maxillary sinus or submandibular space, is a rare intra-operative exodontia complication that is seldom documented. A 44-year-old male patient presented with complaints of pain, discomfort, and limited mouth opening. He had previously attempted to have a tooth extracted, but the procedure resulted in a misplaced tooth. A painful, indurated swelling was observed at the patient's left mandibular angle. Radiographic analyses revealed a radiopaque lesion resembling the third molar tooth root. Utilizing orthopantomography and CT images, the misplaced root in the left submandibular region was accurately located. The tooth was successfully extracted following the elevation of a lingual flap. The patient was prescribed antibiotics and painkillers for 7 days, and he reported an uneventful recovery with no complications on the eighth postoperative day. Accidental displacement of lower third molars or root fragments into neighboring anatomical areas is a rare but potentially concerning complication. Common sites of displacement include the submandibular, sublingual, and pterygomandibular spaces. Risk factors for displacement encompass improper use of surgical instruments and variations in patient anatomical characteristics. The ease of extraction can be influenced by various factors, including the degree of impaction, root structure, and dental inclination. Recommended screening examinations include panoramic radiography, intraoral periapical (PA) radiography, and occlusal radiography. Precise diagnosis and localization necessitate radiographic assessments such as CT scans and panoramic radiography. Postoperative care involves administering analgesics, antibiotics, suturing, wound irrigation, and managing potential complications like swelling, discomfort, infection, and nerve damage. Accidental displacement of lower third molars or their roots into the submandibular region is an infrequent yet potential complication. Thorough case assessment and adherence to established protocols for appropriate access, judicious bone removal, and avoiding excessive force are imperative for clinicians in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Abdullah Nadeem
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | | | - Areeba Ahsan
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Hasan Mushahid
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Rabeea Tariq
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Mahima Rizwan
- Department of BiosciencesShaheed Zulfikar Ali Bhutto Institute of Science and TechnologyKarachiPakistan
| | - Maryam Gul
- Department of MedicineDow University of Health SciencesKarachiPakistan
| | - Nahid Raufi
- Department of MedicineKabul Medical UniversityAfghanistan
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Wihokrut S, Vorakulpipat C, Manosuthi P, Waikakul A. Proximity of mandibular third molar root(s) to surrounding cortical bone: cone beam computed tomography (CBCT) and panoramic findings. Oral Maxillofac Surg 2022; 26:311-319. [PMID: 34374876 DOI: 10.1007/s10006-021-00979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE We evaluated the relationship between mandibular third molar roots (M3Ms) and surrounding cortical bone using cone beam computed tomography (CBCT) and panoramic findings. We studied (a) the location of mandibular third molar roots in relation with cortical bone in terms of contact, penetration, and perforation on CBCT; (b) the relationship between characteristics of a root in panoramic findings and the CBCT image (entire and segmentally); and (c) the relationship of the root plane in panoramic findings vs. CBCT. MATERIAL AND METHODS One hundred five teeth with 224 roots of mandibular third molar from 73 patients were evaluated by using cone beam computed tomography and panoramic image. RESULT The relationships were assessed using 105 images of impacted M3Ms: 104/105 (99%) showed cortical bone involvement (30.4% penetration and 68.6% perforation). The more apical the segment, the higher the proportion of perforation. Most (79.9%) of the M3M roots involved a lingual cortex with 46.9% penetration and 49.2% perforation. The panoramic signs of segmental root images-viz. clear and blurred-were not associated with cortical penetration or perforation. Panoramic signs of individual root images-in the same and different planes-could be used to predict root plane M3M roots. The same appearance in the panoramic image was significantly related to the same plane of the root in CBCT (p-value 0.048). CONCLUSION These findings could contribute to enhanced radiological assessment and surgical planning.
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Affiliation(s)
- Saowapap Wihokrut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, No. 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Chakorn Vorakulpipat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, No. 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Pattamawan Manosuthi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, No. 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Aurasa Waikakul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, No. 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand.
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Masui M, Ibaragi S, Takeshita Y, Iwanaga J, Kunisada Y, Sasaki A. Displacement of lower third molar into floor of mouth: a single institutional experience. Oral Maxillofac Surg 2021; 26:447-453. [PMID: 34596806 DOI: 10.1007/s10006-021-01012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The displacement of the tooth/tooth fragment into the floor of mouth sometimes happens during the lower third molar surgery and the patients are usually referred to oral and maxillofacial surgeons. To date, however, there is no consensus how to manage the displaced tooth due to the lack of available data. METHODS In this study, we have retrospectively analyzed the management of the displaced lower third molar into the floor of mouth. Our institute experienced seven cases during 2010 to 2020. RESULTS Incidence rate of the lingual nerve injury caused by displacement of the lower third molar was 1/7. Six patients out of seven underwent surgical removal of the displaced fragment. The direct approach was used when the fragment was palpable superficially and the fragment was horizontally located away from the lingual plate (2 cases), while when the fragment was not palpable, or was palpable and adjacent to the lingual plate, the lingual mucoperiosteal flap was selected (4 cases). CONCLUSION We conclude that the palpation and preoperative diagnosis with computed tomographic images are significantly important to decide a better and most effective surgical approach.
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Affiliation(s)
- Masanori Masui
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan.
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan
| | - Akira Sasaki
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1Shikata-cho, Kita-ku, Okayama-shi, 700-8525, Japan
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Alexoudi VA, Tatsis D, Zamani K, Zelkas D, Paraskevopoulos K, Vaxtsevanos K. Iatrogenic displacement of impacted mandibular third molars or their roots into adjacent soft tissues and spaces: A report of three cases. Natl J Maxillofac Surg 2020; 11:275-279. [PMID: 33897194 PMCID: PMC8051650 DOI: 10.4103/njms.njms_95_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/03/2020] [Accepted: 06/21/2020] [Indexed: 12/03/2022] Open
Abstract
Iatrogenic tooth displacement is a rather unusual but significant complication during extractions' procedures. The most common anatomic positions of displacement for the lower teeth include the pterygomandibular, submandibular, sublingual, and lateral pharyngeal spaces. A retrospective analysis of three cases of tooth displacement to adjacent anatomic sites is presented. These patients were treated at the Oral and Maxillofacial Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Greece. Two cases refer to displaced roots in the submandibular space, and one refers to a lower third molar displaced in the lateral pharyngeal space. Third molar displacement is a clinical complication that should be considered during mandibular third molar extraction, and proper preventive measures should be taken into consideration.
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Affiliation(s)
- Vaia-Aikaterini Alexoudi
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitris Tatsis
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Zamani
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitris Zelkas
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Konstantinos Vaxtsevanos
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Duarte BG, Vieira JM, Yaedú RYF, Ferreira Júnior O. Immediate Removal of a Dislocated Dental Fragment from the Submandibular Space during Extraction of the Lower Third Molar: Case Report and Literature Review. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n5p459-463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractThis paper aims to report a case of radicular displacement to the submandibular space and to review the literature seeking reports of dental displacements / fragments published in the period from 2007 to 2017 in PubMed evidencing risk factors, prevention and forms of treatment. In this article a case of displacement of dental fragments to the submandibular space with immediate removal is reported. The third molar or its roots displacement into facial spaces is a rare situation. The preoperative surgical planning is fundamental to avoid this type of complication. The association of (1) good surgical planning, (2) surgical technique utilization and adequate instruments, and (3) the surgeon experience are determining factors to avoid the occurrence of this complication. Keywords: Molar, Third. Surgery, Oral. Intraoperative Complications. ResumoA extração de terceiros molares é o procedimento cirúrgico mais frequente nos consultórios odontológicos. Como qualquer cirurgia, existe a possibilidade de complicações trans e pós-operatórias. O deslocamento desses dentes ou fragmento dentário para espaços faciais é raro, com frequência extremamente baixa. Este trabalho tem como objetivo relatar um caso de deslocamento radicular para o espaço submandibular e revisar a literatura buscando relatos de deslocamentos dentários/fragmentos publicados no período de 2007 a 2017 no Pubmed evidenciando fatores de risco, prevenção e formas de tratamento. Nesse artigo nós relatamos um caso de deslocamento de um fragmento radicular para o espaço submandibular, sendo este removido imediatamente. O deslocamento do terceiro molar ou de fragmentos radiculares para os espaços faciais é raro. A avaliação pré-operatória é fundamental para evitar esse tipo de complicação. A associação entre (1) planejamento cirúrgico correto, (2) utilização de técnica e materiais corretos e (3) experiência do profissional, são fatores determinantes para evitar esse tipo de complicação. Palavras-chave: Dente Serotino. Cirurgia Bucal. Complicações Intraoperatórias.
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Torul D, Kazan D, Bereket MC, Karli R. Persistent lingual paresthesia caused by a displaced tooth fragment: a case report and literature review. J Korean Assoc Oral Maxillofac Surg 2017; 43:S9-S13. [PMID: 29354592 PMCID: PMC5770475 DOI: 10.5125/jkaoms.2017.43.s1.s9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/13/2017] [Accepted: 05/07/2017] [Indexed: 11/07/2022] Open
Abstract
Accidental displacement of the third molar tooth or its fragment into the anatomical spaces is a rare but potentially serious complication. The most common sites of mandibular third molar displacement are the sublingual, submandibular, and pterygomandibular spaces. Removal of a displaced tooth or its fragments from these spaces may be difficult due to poor access and the vital structures involved in these spaces; therefore, removal may result in permanent damage. This article is intended to provide a concise update of the reported cases of submandibular displacement and to present a case of intraoral management of mandibular third molar root fragments that were displaced into the submandibular space.
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Affiliation(s)
- Damla Torul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Dilara Kazan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Mehmet Cihan Bereket
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Rifat Karli
- Department of Otorhinolaryngology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Bozkurt P, Erdem E. Management of upper and lower molars that are displaced into the neighbouring spaces. Br J Oral Maxillofac Surg 2017; 55:e49-e52. [PMID: 28735634 DOI: 10.1016/j.bjoms.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach. There were no significant differences in sex, affected side, which part of the tooth was displaced, whether the extracted teeth had erupted, type of anaesthesia, or timing of retrieval. We conclude that this condition should be treated, although follow-up alone may be an option. The intraoral lingual pouch approach for complications of mandibular third molars and the intraoral Caldwell-Luc operation for those in the maxilla could be successful options for retrieval.
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Affiliation(s)
- P Bozkurt
- Ankara University, Faculty of Dentistry, Oral and Maxillofacial Surgery Department.
| | - E Erdem
- Ankara University, Faculty of Dentistry, Oral and Maxillofacial Surgery Department.
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Analyses of anatomical relationship between mandibular third molar roots and variations in lingual undercut of mandible using cone-beam computed tomography. J Dent Sci 2017; 12:261-267. [PMID: 30895060 PMCID: PMC6399996 DOI: 10.1016/j.jds.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/02/2016] [Indexed: 11/25/2022] Open
Abstract
Background/purpose Anatomical features of the lingual undercut region is a potential factor that might increase the risk of displacement of a tooth or fragment. The aim of this study was to report the normal anatomical relationship of impacted lower third molar roots to the lingual cortex and soft tissues of mandible and anatomical variations of lingual balcony in the impacted third molar region. Materials and methods One hundred impacted third molars (54 males, 46 females) from 65 (31 men, 34 women) patients were evaluated for this study using cone-beam computed tomography. Three measurements [bone thickness, angle (Ang) 1 and Ang 2] were recorded on the coronal section slices of cone-beam computed tomography images; in these images, the impacted third molar root was closest to the lingual soft tissues. Results The average distance between the tooth root and the lingual outer cortical bone layer (bone thickness) was 1.03 mm. The averages of Ang 1 and Ang 2 were 140.61° and 153.44°. Ang 1 and Ang 2 of female patients were larger than those of male patients. Conclusion The narrow angulation of the lingual balcony region and the relationship between roots and lingual soft tissues should be noted to avoid undesirable complication of displacement of a tooth or fragment into sublingual, submandibular, and pterygomandibular spaces. There was no relation in the floor of the mouth between the position of the impacted third molar roots and different lingual undercut angulation variations.
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