Delayed minimally invasive treatment of an infected mandibular angle fracture after wisdom tooth removal: A case report with 2 years follow up

Abstract

Introduction

This case report describes the treatment of an infected mandibular angle fracture 50 days after wisdom tooth removal.

Case presentation

A 57-year-old woman with a history of mandibular right wisdom tooth extraction 50 days earlier presented to our clinic with restricted mouth opening, significant pain, paresthesia in her right chin, and fever (temperature, 38.5 °C). Intraoral examination revealed malocclusion and an open purulent laceration of the soft tissue in the 48 region. Orthopantomography and computed tomography revealed a displaced fracture of the right mandibular angle and bone loss secondary to infection.

Three-phase treatment comprising wound debridement, open reduction internal fixation, mandibulomaxillary fixation, and reconstruction using autologous iliac bone graft resulted in successful osseous healing. Satisfactory centric occlusion and jaw opening within the normal range with no mandibular deviation were achieved.

Clinical discussion

Wisdom tooth extraction is a common oral and maxillofacial procedure, of which mandibular fracture is an uncommon complication. Iatrogenic mandibular fractures are extremely rare, with an incidence of 0.005 %. Treatment involving debridement of the infected site and rigid internal fixation via an intraoral approach can reduce the incidence of facial nerve injury and scarring.

Conclusion

Impacted wisdom teeth must be extracted after careful consideration and using appropriate techniques. Complications such as mandibular fractures warrant early treatment in a specialist clinic to minimize further complications.