PDF: Delayed removal of maxillary third molar displaced into the infratemporal fossa

Third molar extraction is a common procedure and it is rarely associated with complications.

third-molar


One complication that may be associated with this procedure is displacement of the tooth into the infratemporal fossa, an anatomical structure that contains the temporalis muscle, medial and lateral pterygoid muscles, the pterygoid plexus, the maxillary artery and its branches, the mandibular nerve and its branches, and the chorda tympani. The present case report illustrates delayed surgical removal of a maxillary third molar that was displaced into the infratemporal fossa, via the intraoral access and under local anesthesia. Despite the rarity of this complication, oral and maxillofacial surgeons should be aware of its management and able to choose the optimal technique, taking into account the patient's signs and symptoms as well as the knowledge and experience of the surgeon.


Common complications of mandibular third molar surgery include alveolar osteitis (dry socket), secondary infection, nerve dysfunction, and hemorrhage.4 When manipulation of a maxillary third molar is required, other types of complication may arise, such as tuberosity and root fracture, oroantral communication, and displacement of the tooth into adjacent structures, including displacement into the infratemporal fossa.

The infratemporal fossa is an irregularly shaped space located below the greater wing of the sphenoid bone (containing the foramen ovale), lateral to the ramus of the mandible and the gap between the zygomatic arch and temporal bone (forming the communication to the temporal fossa). 

The lateral pterygoid plate forms the medial margin while the maxilla forms the medial aspect of this space. The temporalis muscle, medial and lateral pterygoid muscles, pterygoid venous plexus, mandibular nerve and its branches, maxillary artery and its branches, and the chorda tympani nerve are all contained in the infratemporal fossa.6 The parapharyngeal space lies medially and communicates with the mediastinum.




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