J Oral Maxillofac Surg69:1301-1303, 2011

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gic(argethapoofacsphacotomcoofbetheinfintantiociabupharyngeal, and parotid spaces.4 A review of the pub-lished data showed that all dislodged teeth into the

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doiinfratemporal space were maxillary third molars. Wecould not find a case of mandibular third molar havingbeen displaced into the infratemporal space. The ac-cepted treatment is removal of the displaced teeth orroot fragments to prevent future infection.3 There-fore, patients must be urgently referred to a maxillo-facial surgeon after the administration of prophylactic

Address correspondence and reprint requests to Dr Mortazavi:

partment of Oral Medicine, University of Medical Sciences Hama-

Dental School, Next to Mardom Park, Hamada, Iran; e-mail:

rtazavi@umsha.ac.ir

011 American Association of Oral and Maxillofacial Surgeons

8-2391/11/6905-0019$36.00/0

:10.1016/j.joms.2010.06.215First Report of Accidof Mandibular T

InfratempReza Shahakbari,* Hamed Mor

e of the most common procedures in the dentalce is surgical removal of the maxillary or mandibularrd molars.1 Of the complications associated withrd molar extraction, the most commonly mentionedve been dysesthesia, alveolar osteitis, infection, hem-hage, fracture of the mandible, and damage to thejacent teeth. Accidental displacement of the fracturedts or teeth into the submandibular, pterygomandib-r, and sublingual spaces is a less common complica-n.2,3 One of the very rare occurrences during man-ular third molar extraction is displacement of theth into the infratemporal space, such as reported inpresent study. A review of the published data re-

aled little information on the incidence, cause, andnagement of displaced tooth and root fragments.2

se Report

A 23-year-old female patient was referred from her gen-l practitioner to the clinic of oral and maxillofacial sur-y of the Mashhad Dental School with a complaint ofited mouth opening and pain in the left temporal areaer surgical extraction of the mandibular third molar 1ek prior from the left temporal area. The intraoral clinicalamination revealed tissue damage in the left temporal. She had a mouth opening of about 15 mm, making itficult to perform intraoral examinations or take photo-phs. A panoramic radiograph suggested the presence ofooth apparently near the left coronoid process (Fig 1).is resulted in a decreased coronoid process range oftion and maximal mouth opening. The tooth socketuld be seen in the left side of the orthopantomogram

Assistant Professor, Department of Oral and Maxillofacial Sur-

y, University of Medical Sciences Mashhad Dental School, Mash-

, Iran.

Assistant Professor, Department of Oral Medicine, University of

dical Sciences Hamadan Dental School, Hamadan, Iran.

Assistant Professor, Department of Oral and Maxillofacial Sur-1301tal Displacementrd Molar Intoal Spacevi, and Majid Eshghpour

PG) (Fig 1). The presence of the tooth was clearly re-led, adjacent to the coronoid on the patients computedography scan, especially the 3-dimensional computedography scan (Figs 2, 3). Initially, physiotherapy was

nducted for 10 days, to rectify the limitation in mouthening if it had been caused by factors other than thechanical obstacle of the tooth adjacent to the coronoid.wever, after physiotherapy, no change in the mouthening had occurred. The removal of the tooth was at-pted with the patient under local anesthesia 20 days

er the initial operation. Access was achieved by a highus incision, similar to a coronoidectomy incision, andtooth was removed. Immediately after surgery, the ex-t of mouth opening had increased. At 1 week afteroving the tooth, her maximal mouth opening was 40. At present, the patient has had no complaints.

scussionThe incidence of complications associated with sur-al removal of the third molar has been moderateound 10%). However, trained experienced sur-ons have had a lower incidence of complicationn general dentists.3 Fenestration of alveolar bone, aor selection of surgical methods, and incorrect usean instrument could be some factors resulting incidental displacement of a tooth into the anatomicaces. Uncontrolled force during the use of elevatorss been reported as the most usual cause of thesemplications.2,3 In the present case, the computedography findings showed damage to the lingual

rtex that might have been related to displacementthe tooth into the infratemporal space. However,cause this entity is very rare, we could not explainactual cause of the tooth displacement into the

ratemporal space. The infratemporal space is at theersection of the deep temporal space superiorlyd the pterygomandibular space inferiorly. Infec-ns of the infratemporal spaces are most often asso-ted with the contiguous spaces, specifically theccal, pterygomandibular, deep temporal, lateral

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1302 ACCIDENTAL DISPLACEMENT OF MANDIBULAR THIRD MOLARFIGURE 1. OPG suggesting tooth displaced into infratemporal space and its socket.

hakbari et al. Accidental Displacement of Mandibular Third Molar. J Oral Maxillofac Surg 2011.FIGURE 2. Computed tomography scan showing displaced tooth and damaged lingual cortex in left side of mandible.

hakbari et al. Accidental Displacement of Mandibular Third Molar. J Oral Maxillofac Surg 2011.

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SHAHAKBARI ET AL 1303tibiotics.5 In conclusion, good selection of the sur-al method and the correct use of instruments areommended.

ferencesYaclin S, Akta I, Atalay B: Accidental displacement of a high-speedhand piece bur during mandibular third molar surgery: A case report.Oral Med Oral Pathol Oral Radiol J Endod 105:E29, 2008

URE 3. Three-dimensional computed tomography scan showinion.

hakbari et al. Accidental Displacement of Mandibular Third MoTumuluri V, Punnia-Moorty A: Displacement of a mandibularthird molar root fragment into the pterygomandibular space.Austra Dent J 47:68, 2002Sverzut CE, Trivellato AE, Defigueiredolopes LM, et al: Acciden-tal displacement of impacted maxillary third molar: A case re-port. Braz Dent J 16:167, 2005Fonseca RJ, Williams TP, Stewart JC: Oral and MaxillofacialSurgery. Philadelphia, WB Saunders, 2000Durmus E, Dolanmaz D, Kucukkolbsi H, et al: Accidental dis-placement of impacted maxillary and mandibular third molar.Quintessence Int 35:375, 2004

ence of tooth in infratemporal space near coronoid process

Oral Maxillofac Surg 2011.2.

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First Report of Accidental Displacement of Mandibular Third Molar Into Infratemporal SpaceCase ReportDiscussionReferences