Displacement of a maxillary third molar into the buccal space: anatomical implications apropos of a case

Abstract

A few cases of accidental displacement of molars into adjacent anatomical spaces, such as the infratemporal fossa, the pterygomandibular space, the maxillary sinus, or the lateral pharyngeal space, during surgical interventions have been reported. This report describes the displacement of a maxillary third molar into the buccal space and discusses the anatomical implications.

The buccal space is a deep fascial space that lies adjacent to the maxillary alveolar ridge and is enclosed by the buccinator muscle, the masseter muscle, the zygomaticus major and minor muscles, the superficial layer of the deep cervical fascia, the external and internal pterygoid muscles, and the mandible . According to the literature, accidental displacement of a tooth into adjacent anatomical spaces such as the maxillary sinus, the infratemporal fossa, the lateral pharyngeal space, or the pterygomandibular space has rarely been reported . Table 1 reviews previously published data regarding the displacement of maxillary third molars into different anatomical spaces. This article describes a case of displacement of a maxillary third molar into the buccal space and discusses the anatomical implications.

Table 1
Displacement cases reported in the English literature.
Authors Maxillary sinus ( n ) Infratemporal fossa ( n ) Temporal fossa ( n )
K illey & K ay 1964 1
W inkler et al., 1977 1
O berman et al., 1986 2 1
G ulbrandsen et al., 1987 1
G randini et al., 1992 2
D awson et al., 1993 1
P atel & D own , 1994 1
P aoli et al., 1995 2
E lgbouri et al., 1999 1
O rr , 1999 1
D urmus et al., 2004 1
S verzut et al., 2005 1
D imitrakopoulos & P apadaki , 2007 1
S verzut et al., 2009 1
Total 5 10 3

Case report

A 32-year-old female was referred to the authors’ department by her private dentist, who had attempted to remove her right maxillary third molar, but the tooth had disappeared during the surgical intervention. The patient’s temperature was 39 °C; she had malaise as well as local pain, swelling, and an elevated temperature in the buccal area. Her mouth opening was limited to 1 cm. A lateral radiograph showed the upper third molar positioned anterior to the ramus, at the level of the crowns of the second molars. A computed tomography (CT) examination revealed that the displaced tooth had moved into the buccal space; it was stuck between the masseter and buccinator muscles ( Fig. 1 ). 3D CT images showed that the tooth was situated anterior and medial to the anterior margin of the ramus, with its crown level distal to the second molar and a long axis extending in a bucco-palatinal and medio-lateral direction ( Fig. 2 ). The patient was administered antibiotic and analgesic/antipyretic therapy. After 1 week, her high temperature, swelling, and pain were all resolved and she showed no sign of difficulty in opening her mouth. The tooth was easily palpable in the buccal area during the intraoral examination. Under local anaesthesia, following a submucosal incision underneath the parotid papilla, the tooth was reached via blunt dissection. The crown of the tooth was rotated with the help of a periosteal elevator and orientated with the incision line. The most interesting part of the intervention was the separation of the fibrous connection between the periodontal structure on the surface of the tooth and the adipose tissue. After separating the tooth from the adipose tissue, the submucosal and mucosal tissues were sutured with 3.0 catgut ( Fig. 3 ). Postoperatively, non-steroid anti-inflammatory, analgesic, and antibiotic drugs were given to the patient; she recovered without incident.

Feb 7, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Displacement of a maxillary third molar into the buccal space: anatomical implications apropos of a case
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