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Wisdom tooth operations are sometimes accompanied by complications. This case report shows complications during upper jaw third molar removal. Expectable problems during oral surgery should be planned to be solved in advance. Displacement of the third molar during oral surgeries as a considerable complication is rarely discussed scientifically. A g...
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Context 1
... clinical diagnostics, the CBCT showed the dislocated tooth in the infratemporal fossa closed to the zygomatic arch. The axial cross-sections of the CBCT also displayed the precise localization of the tooth [ Figure 1]. The volumetric CBCT reconstruction for location identification showed the entire tooth in the infratemporalis fossa [ Figure 2]. ...
Citations
... However, as complications, such as infection, foreign body reaction or trismus, as reported in this case 8 , may increase if the retrieval is delayed. Regard less the timing of the surgery, several surgical approaches have been used successfully, like Caldwell-Luc approach or resection of the coronoid process 9,10 . The complication in all such cases is quite high and that should be considered before proceeding further. ...
Impacted third molar surgery is one of the complicated dentoalveolar surgeries. By having appropriate safety measures these surgeries can be caried out without much complication. Removal of impacted third maxillary molar is frequently carried out without difficulties and low rate of intraoperative complications. Here we are presenting an uncommon case of an impacted maxillary third molar having peri-apical abscess that was unintentionally displaced into the infra temporal space during its extraction. Displaced tooth was retrieved from infratemporal fossa region under general anaesthesia. It is a very rare complication to be happen during routine surgical extraction of maxillary impacted third molar tooth. Key words: Maxillary third molar, Infra-temporal fossa, Displacement of tooth, Dentoalveolar surgery, Surgical Complication.
... In contrast to mandibular M3, germectomy of maxillary M3 is more difficult and time-consuming because of the higher tooth bud position 17 . Several authors have reported surgical removal of maxillary M3 in young patients with displacement of the tooth bud into the infratemporal fossa [23][24][25][26] . One author stated that M3 removal presents operative challenges, and germectomy should be limited to mandibular tooth buds 27 . ...
Germectomy is a surgical method most typically performed in young adults. The indications for treatment are controversial. The purpose of this review was to determine the correct indications for germectomy and to discuss the advantages and disadvantages of the procedure. We reviewed the surgical techniques (anesthetic methods, patient preparation, and flap designs) and complications. Germectomy for orthodontic purposes is a common indication for surgical removal of tooth germ among young patients. Several studies have supported removal at an earlier age to produce fewer surgical complications. Several surgical techniques have been described in the literature.
... The intra oral approach has a very satisfactory success rate and has the advantage of leaving no aesthetic damage, as well as limited postoperative effects in the absence of complications [25,28,29]. Even if the incision at the bottom of the vestibule is the most practiced, the intrasulcular incision may seem more comfortable [16,23]. ...
Introduction: Projection of the maxillary third molar into the temporal or infra temporal fossa is a rare complication. There is no recommendation for the management of such complication. The aim of this work is to try establishing a removal protocol. Materials and methods: A systematic review of the literature was conducted using all cases reports of iatrogenic projection of the tooth into the temporal fossa or infratemporal fossa and how they were treated. The last search was conducted in July 2021. Results: 27 cases involving 28 teeth, published between 1986 and 2020 were included. Discussion: The intraoral approach seems to be preferred in the first instance for teeth in the infra temporal fossa and a cutaneous approach for teeth in the temporal fossa. This should be done within 3–6 weeks after projection to attempt removal. This allows the formation of a fibrous capsule and the downward migration of the tooth to facilitate removal. The use of complementary technological means can improve the chances of success. Conclusion: Resulting a flow chart, who is an aid to management of this type of situation, providing a clear idea of the approach to be taken.
... Les déplacements accidentels des dents de sagesse du maxillaire supérieur dans 50 divers régions anatomiques sont rares [1,2]. Nous avons procédé d'abord à la articles [16][17][18][19] accessibles en accès ouvert (pdf gratuit pour les lecteurs). ...
... Le déplacement accidentel de la dent de sagesse au maxillaire supérieur peut se faire 119 vers diverses régions anatomiques ( Figure 1) : 1) la fosse infra-temporale avec le 120 plus de cas publiés dans la littérature [4,5,8,10,11,14,16,17] ; 2) le sinus 121 maxillaire [12,15] ; 3) l'espace latéro-pharyngé [7] ; 4) la région de la tubérosité ...
... L'examen complémentaire de choix est actuellement le CBCT pour la localisation 143 exacte de la dent [16,18]. ...
Les déplacements accidentels des dents de sagesse du maxillaire supérieur dans divers régions anatomiques sont rares. Nous avons effectué la recherche de littérature sur ce sujet de manière systématique en utilisant PubMed et DOAJ. Il n’existe pas d’illustration accessible gratuitement pour les voies de déplacements accidentels des dents de sagesse supérieurs imagées par le CT scan ou par le CBCT à part le déplacement vers la fosse infra-temporale et vers la fosse ptérygopalatine. Nous décrivons et illustrons par CBCT un cas unique dans la littérature médicale de déplacement accidentel du germe de la dent de sagesse du maxillaire supérieur dans l’espace jugal antérieur. Les raisons potentielles, les conséquences ainsi que les moyens de prévention de cette rare complication d’extraction de dents de sagesse sont aussi expliquées.
... In the literature, there are a number of articles focusing on the retrieval of the upper third molars from the infratemporal fossa with various access options at different intervention times. [1][2][3][4] The aim of this case report is to present the modified Gillie's temporal approach used to remove a displaced maxillary third molar from infratemporal fossa. ...
... Postoperatively, lateral cephalogram and Paranasal sinus (PNS) view X-rays were taken [ Figure 3]. [2][3][4][5][6][7][8][9][10] dIscussIon The Le Fort I osteotomy is commonly used for the correction of malocclusion and maxilla-mandibular deformities. Because it allows for movement in all three planes, it is used to treat Class II and III malocclusions, as well dentofacial asymmetries. ...
... Even more severe complications such as diplopia are reported. [2,7,13,14] The exact localization of the displaced tooth is impossible to determine clinically and radiographic examination is indicated. The superimposition of the anatomic structures located at the site of the infratemporal, temporal, and pterygopalatine fossa may disorient the diagnosis in the case, hence to determine the precise and detailed location of the dislodged tooth computed tomography examination is needed. ...
Tooth impaction is a pathological situation where a tooth is unable to achieve its normal functional position within the expected time span. The removal may be associated with intra-operative or post-operative complications. The Le Fort I osteotomy is a procedure used by maxillofacial surgeons to correct a wide range of dentofacial deformities. Due to its versatility and simplicity, it has gained popularity for a wide range of uses. This case report describes the location and surgical removal of a right maxillary third molar which was accidentally displaced into the infratemporal fossa in a 26-year-old female while performing Le Fort I osteotomy. The patient underwent a second surgery for the retrieval of tooth using modified Gillie's temporal approach. The important role of the cone beam computed tomography in determining the localization of the displaced tooth is demonstrated.
... Usually the tooth is lateral to lateral pterygoid plate and inferior to lateral pterygoid muscle. Position of the tooth may change by the movement of the muscles and recent CT or MRI is recommended before surgical intervention [44,46]. Different surgical approaches have been described to remove displaced teeth into the ITF. ...
... Event hough, impacted tooth in the infratemporal region is a rare case, displacement of a maxillary third molar into infratemporal fossa is a potential complication of a maxillary third molar extraction. [29][30][31][32] Incorrect extraction technique, distolingual angulated tooth, decreased visibility during the surgical procedure or limited bone existence are common causes of teeth displacing to the infratemporal fossa during the extraction of maxillary third molars. 30 On the panoramic radiograph, there are many superpositions on the infratemporal region, therefore, CBCT is more useful for determining the position and the morphology of the tooth. ...
... The displacement of maxillary third molars into the infratemporal fossa is usually associated with an incorrect extraction technique, distopalatal angulated tooth, decreased visibility during surgical removal or lack of bone distal to the tooth. Hence, an adequate surgical full-thickness flap, a congruent extractive force and the use of a distal retractor as the Laster retractor is highly recommended (12)(13)(14)(15). Clinically, a patient with a displaced tooth into the infratemporal fossa could be asymptomatic or present swelling, pain, limitation of the mandibular motion and trisma (2,3). ...
... Conventional radiographic examination could disorient the operator due to the superimposition of anatomical structures: it could be necessary both panoramic, occipitomental, occlusal and lateral views. CT or CBCT examination should be encouraged due to their superiority in quality of the images and because they provide an exact localization of the displaced tooth (4,5,14,16,17). Access to the infratemporal fossa is difficult and dangerous for the presence of vital structures running through it and the operator should not embark on potentially complicated and hazardous surgical procedures to retrieve the displaced tooth (5). An incautious attempt to remove the displaced tooth could lead to serious risk of hemorrage or neurologic injury and it may ultimately fail to retrieve the tooth, pushing it deeper into the tissues (18). ...
Background
The displacement of a third molar is a rare occurrence, but it could lead to serious and/or life threatening complication. Aim of this review is to understand the most correlated causes of displacement and the possible solutions proposed in literature to avoid and solve this complication for maxillary and mandibular third molars at the appropriate time.
Material and Methods
A search for “third molar displacement” was performed by using Pubmed database. Articles referred to soft tissues displacement, from 1957 to 2018, were included in the review. The references lists of all eligible articles were examined and additional studies were added to the review only if indexed on Pubmed. All the articles on maxillary sinus displacement and the dislocation of dental fragments or surgical equipment were excluded.
Results
From a total of 134 results, 68 articles were examined for satisfying inclusion criteria. 18 articles were excluded because not inherent with the topic; 19 articles on infratemporal space, 11 on sublingual space, 9 on submandibular space, 11 on lateral pharyngeal space displacement were considered congruent for the review and included.
Conclusions
The displacement of the third molar in deeper tissues could be avoided by the use of proper surgical procedures and instrumentarium. If displacement occurs, and the operator could not reach the tooth in safe conditions, the patient should be immediately referred to a maxillo-facial surgeon, because of the possibility of further displacement or the onset of hazardous or potentially fatal infections in vital regions.
Key words:Third molar, wisdom tooth, maxillary, mandibular, displacement.
One of the intraoperative complications of third molar surgery is the displacement of the tooth to adjacent anatomical spaces. This accident represents a small percentage of complications and is attributed to inadequate clinical planning and management. This report will specifically address the accidental displacement of upper third molars to the infratemporal fossa. A search was conducted by using the PubMed database with the keywords "third molar displacement", a total of 22 articles were included according to the inclusion criteria. Two cases of displacement of the upper third molar to the infratemporal fossa managed at the Centro Academico de Atencion Odontologica (CAAD) of the Tecnologico de Monterrey will be reported. The aim of this paper is to present a management protocol for this complication.
