Accidental displacement of mandibular Third molars into the submandibular space – Two case reports, a suggested surgical approach and management algorithm

Chubb, David W. R.; Kang, Ben; Tong, Nicholas

doi:10.1016/j.jormas.2020.08.001

Cited by 10 publications

(14 citation statements)

References 10 publications

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“…4,12,16 Iatrogenic displacement of teeth into fascial spaces is a rare but significant complication. [1][2][3][4][5][6][7][8][9][10] Commonly, the displacement of teeth into fascial spaces is also associated with third permanent molars, 11 with the most frequent sites of displacement being the maxillary sinus and submandibular space. 3,5,6,14 Other sites of displacement include the infratemporal, sublingual, pterygomandibular and lateral pharyngeal spaces.…”

Section: Tooth Displacementmentioning

confidence: 99%

“…However, special investigations are often necessary to localise the tooth. 6,8 Prior to performing retrieval, the tooth should be localised with at least a onedimensional image, 14 such as panoramic, postero-anterior, submento-vertex and occlusal views, in addition to image intensifiers. [10][11][12]18 Computed Tomography (CT) or Cone-Beam Computed Tomography (CBCT) is desirable due to exact localisation and is indicated when plain film imaging is not conclusive.…”

Section: Special Investigationsmentioning

confidence: 99%

“…[10][11][12]18 Computed Tomography (CT) or Cone-Beam Computed Tomography (CBCT) is desirable due to exact localisation and is indicated when plain film imaging is not conclusive. 4,5,[7][8][9][10]12,16,19 CBCT is preferable to a standard CT due to its lower radiation dose as compared with a standard CT. 3,12,19 However, choice will be partly dependant on the availability of such modalities within the particular secondary care setting. In this case, CBCT was not readily available and as such a standard CT of the mandible was performed to localise the root and avoid any further delay in patient care.…”

Section: Special Investigationsmentioning

confidence: 99%

“…The timing as to when retrieval intervention should take place is debateable [3][4][5][6][7][8]10,17 and can depend on factors such as the anatomical space involved, the size of the displaced fragment, delay in presentation and the presenting symptoms. Displacement into the lateral pharyngeal space, for example, carries the risk of life-threatening complications if infection ensues.…”

Section: Timing Of Retrievalmentioning

confidence: 99%

“…

Iatrogenic displacement of teeth during extraction is a rare but significant complication. [1][2][3][4][5][6][7][8][9][10] When it does occur, it is more often associated with the displacement of third permanent molars into fascial spaces. 11 We present a rare case of a 30-year-old female patient who presented to our department with significant intraosseous displacement of a mandibular premolar root during attempted extraction, resulting in paraesthesia.

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Accidental intraosseous displacement of mandibular premolar root during extraction with guidance and literature review

2021

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Section: Tooth Displacementmentioning

confidence: 99%

Section: Special Investigationsmentioning

confidence: 99%

Section: Special Investigationsmentioning

confidence: 99%

Section: Timing Of Retrievalmentioning

confidence: 99%

“…

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Accidental intraosseous displacement of mandibular premolar root during extraction with guidance and literature review

2021

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A rare case of mandibular third molar displaced into submandibular space: A complication of mandibular third molar extraction

Nadeem,

Vohra,

Ahsan

et al. 2023

Clinical Case Reports

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Key Clinical MessageAccidental 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.AbstractIn 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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Displacement of lower third molar into floor of mouth: a single institutional experience

Masui

Ibaragi

Takeshita

et al. 2021

Oral Maxillofac Surg

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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. MethodsIn 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. ResultsIncidence 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). ConclusionWe 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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Accidental displacement of mandibular Third molars into the submandibular space – Two case reports, a suggested surgical approach and management algorithm

Cited by 10 publications

References 10 publications

Accidental intraosseous displacement of mandibular premolar root during extraction with guidance and literature review

Accidental intraosseous displacement of mandibular premolar root during extraction with guidance and literature review

A rare case of mandibular third molar displaced into submandibular space: A complication of mandibular third molar extraction

Displacement of lower third molar into floor of mouth: a single institutional experience

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