Inappropriate Management After Accidental Displacement of Upper Third Molar to the Infratemporal Fossa May Disrupt Its Subsequent Removal

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Excerpt

The removal of the impacted third molar is one of the most common procedures performed by oral and maxillofacial surgeons with low rate of complications and morbidity.1–3 A common complication found during the removal of the upper third molar teeth is the displacement of a tooth fragment or root to the maxillary sinus1,2 and less often reported other areas.3–5 Thus, the tooth root fracture, perforation of the maxillary sinus, tooth displacement to maxillary sinus, tuber fracture, and prolapse of buccal fat are the some surgical accidents reported by the literature.
We are showing a case of 19-year-old female who searched our Oral and Maxillofacial Surgery Team to assessment of a third molar previously displaced to the infra-temporal fossa. On clinical examination, facial swelling and trismus was observed. An orthopantomography showed the left upper third molar displaced in a posterior region (Fig. 1). On computed tomography examination, it was observed displacement of this teeth to the distal margin of the maxillary tuberosity and anterior edge of the lateral pterygoid plate, more specifically in a lower position of the infra-temporal fossa (Fig. 2A–C).
The procedure was performed under general anesthesia and the approach chosen was a vertical incision at the medial upper second molar extended to horizontal at the posterior ridge crest. The mucoperiosteal flap was elevated and a fibrous tissue was found on the region of the lateral pterygoid and ligament limited outwardly by the insertion of the temporal muscle on the mandible coronoid. The tooth was carefully removed avoiding movements that could carry the tooth to other spaces. The incision was closed by first intention. There was no complication in the postoperative follow-up.
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