Nice story with full details
A 17-year-old female student has referred for prophylactic removal of 4 unerupted third molars due to dental crowding. She had no medical history.
Teeth extraction was planned in two sessions under local anesthesia
A 17-year-old female student has referred for prophylactic removal of 4 unerupted third molars due to dental crowding. She had no medical history.
Teeth extraction was planned in two sessions under local anesthesia
The extraction of the left upper and lower third molar teeth was uneventful.
During the second step 2 weeks later, the right upper third molar was accidentally pushed upward and laterally and became unreachable. Immediate retrieval maneuvers were unsuccessful.
wound was closed
During the second step 2 weeks later, the right upper third molar was accidentally pushed upward and laterally and became unreachable. Immediate retrieval maneuvers were unsuccessful.
wound was closed
An immediate postoperative cone-beam computed tomography (CBCT) scan showed displacement of the third molar to the (Infratemporal fossa) up to the level of the sigmoid notch of the mandible.
The position of the tooth was horizontal, with the crown being posterior.
The position of the tooth was horizontal, with the crown being posterior.
A computed tomography (CT) scan acquired 3 weeks later shows that tooth moved to inverted upside-down position and get low at the level of mandible lingula
The lack of solid cranial support of the tooth observed on the CT scan led to the patient being at risk of further upward displacement during a retrieval attempt.
So combined surgical and image-guided approach was decided.
So combined surgical and image-guided approach was decided.
The plan was retrieval procedure under general anesthesia using nasotracheal intubation was performed in the interventional 4D MSCT scan unit, 2 months after the initial extraction attempt.
she did not complain from any significant symptoms, there was no emergency for retrieval.
she did not complain from any significant symptoms, there was no emergency for retrieval.
First step, radiologists inserted a 12 Gauge bone trocar (Bonopty®-AprioMed AB, Sweden) under CT-guidance (Toshiba MEC Aquilion ONE®) through the superior buccal sulcus by an ascending approach.
The trocar was positioned exactly between the tooth apices to provide cranial support
The trocar was positioned exactly between the tooth apices to provide cranial support
The extraoral end of the trocar was then gently tilted upward to push the crown downward. Finally, after marking the parotid duct papilla and infiltrating the mucosa using adrenaline and epinephrine 1%, an incision was performed through the posterior superior buccal sulcus.
The crown was identified and easy retrieval using a Kelly forceps was achieved.
The right lower molar was extracted simultaneously.
The surgical approach was closed using 3/0 polyglactin absorbable sutures, amoxicillin–clavulanate (1 g × 3/day) was administered orally for 3 weeks
The right lower molar was extracted simultaneously.
The surgical approach was closed using 3/0 polyglactin absorbable sutures, amoxicillin–clavulanate (1 g × 3/day) was administered orally for 3 weeks
The CT-guided insertion of the trocar in the appropriate position took a total of 19 min.
The surgical retrieval took 3 min.
X-ray total dose was 284.00 mGy
No significant edema, pain, or mouth opening limitation after 6h
discharged
Postop follow-up at 3 wks 1 yr no complication
The surgical retrieval took 3 min.
X-ray total dose was 284.00 mGy
No significant edema, pain, or mouth opening limitation after 6h
discharged
Postop follow-up at 3 wks 1 yr no complication
How a very simple procedure, changed dramatically, and how these professional people could cover the complications.
it's not about you do the procedure only, but you should cover the complication when it happening.
for further reading:
#MOESM1" target="_blank" rel="noopener" onclick="event.stopPropagation()">bmcoralhealth.biomedcentral.com
it's not about you do the procedure only, but you should cover the complication when it happening.
for further reading:
#MOESM1" target="_blank" rel="noopener" onclick="event.stopPropagation()">bmcoralhealth.biomedcentral.com
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