• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.167-170
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• 1994

The surgical removal of the wisdom teeth is obligate when forceps extraction fails or when the wisdom teeth are impacted. The surgical removal of impacted maxillary third molars is a commonly performed procedure usually associated with few complications & little morbidity. The most frequent complications are tooth root fracture, maxillary tuberosity fracture, tooth displacement into the maxillary sinus & oroantral fistula formation. A rarely reported complication is the displacement of a tooth into the infratemporal fossa. The method of prevention of this complication is by the placement of either a finger or periosteal elevator posterior to the tooth during extraction. To remove the displaced upper third molar is very difficult & has many complications, e.g., persistent bleeding & nerve damage. When the wisdom teeth is displaced, it is initially necessary to gain access to bone by developing a mucoperiosteal path of delivery is developed by additional bone removal or, preferably planned sectioning of the tooth. There are many approaching techniques to remove the displaced upper third molar. This following report describes the surgical technique of displaced upper third molar in the pterygopalatine fassa by the midpalatal ＆transpharyngeal approach.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.91-95
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• 2023

This study examined the effects of a vertical incision on postoperative edema after third molar extraction. The study design was that of a comparative split-mouth approach. Evaluation was performed via magnetic resonance imaging (MRI). Two patients with homogeneous bilateral impacted mandibular third molars were enrolled. These patients underwent facial MRI within 24 hours after simultaneous extraction surgery. Modified triangular flap and enveloped flap incisions were made. Postoperative edema was evaluated by MRI and was assessed according to anatomical space. The two pairs of homogeneous extractions demonstrated that vertical incisions were associated qualitatively and quantitatively with extensive postoperative edema. The edema associated with these incisions spread toward the buccal space, beyond the buccinator muscle. In conclusion, a vertical incision with mandibular third molar extraction was related to edema in the buccal space and the fascial space, which contributed to clinical facial swelling.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.40.1-40.7
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• 2019

Background: Through the analysis of clinical data, we attempted to investigate the etiology and determine the risk of severe iatrogenic lingual nerve injuries in the removal of the mandibular third molar. Methods: A retrospective chart review was performed for patients who had undergone microsurgical repair of lingual nerve injuries. The following data were collected and analyzed: patient sex, age, nerve injury side, type of impaction (Winter's classification, Pell and Gregory's classification). Ratios for the respective lingual nerve injury group data were compared with the ratios of the respective data for the control group, which consisted of data collected from the literature. The data for the control group included previous patients that encountered various complications during the removal of the mandibular third molar. Results: The lingual nerve injury group consisted of 24 males and 58 females. The rate of female patients with iatrogenic lingual nerve injuries was significantly higher than the control groups. Ages ranged from 15 to 67 years, with a mean age of 36.5 years old. Lingual nerve injury was significantly higher in the patient versus the control groups in age. The lingual nerve injury was on the right side in 46 and on the left side in 36 patients. There was no significant difference for the injury side. The distoangular and horizontal ratios were the highest in our lingual nerve injury group. The distoangular impaction rate in our lingual nerve injury group was significantly higher than the rate for the control groups. Conclusion: Distoangular impaction of the mandibular third molar in female patients in their 30s, 40s, and 50s may be a higher risk factor of severe lingual nerve injury in the removal of mandibular third molars.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.6
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• pp.278-284
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• 2014

Objectives: This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage. Materials and Methods: Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimensional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated. Results: When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the mandibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images. Conclusion: The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.5
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• pp.281-283
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• 2015

Extraction of an impacted third molar is one of the most frequently performed techniques in oral and maxillofacial surgery. Surgeons can suffer numerous external injuries while extracting a tooth, with percutaneous injuries to the hand being the most commonly reported. In this article, we present a case involving a percutaneous injury of the surgeon's femoral region caused by breakage of the fissure bur connected to the handpiece during extraction of the third molar. We also propose precautions to prevent such injuries and steps to be undertaken when they occur.

• Imaging Science in Dentistry
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• v.52 no.2
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• pp.231-238
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• 2022

Intraosseous xanthoma of the mandible is a rare benign disorder. A 17-year-old male patient presented with a suspected abscess in the right mandibular third molar, detected on a panoramic radiograph. The patient had no history of systemic or lipid-related metabolic diseases and complained of no specific symptoms or pain. A radiographic examination revealed a heterogeneous radiolucency extending from the apical to the distal aspect of the right mandibular third molar tooth germ. The lesion measured 9 × 16 × 24 mm (antero-posterior × mediolateral × supero-inferior) and showed a relatively well-defined, multilocular, foamy appearance with hyperostotic borders spreading to the inferior alveolar nerve canal. After excisional biopsy, a diagnosis of central xanthoma was made. The lesion recurred, and intraoral vertical ramus osteotomy was done near the lesion. For the treatment of xanthoma of the mandible, extensive and delicate surgical treatment under general anesthesia should be considered.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.5
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• pp.332-336
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• 2012

Purpose: The third molar extraction is one of the mostly performed procedures in the department of oral and maxillofacial surgery. In most of dental clinic or hospital, the third molar extraction used to be frequently performed in an office-based surgery, and most patients did not have specific medical history with young ages. Medical history taking are dependent on the only way by asking to the patients about their individual conditions. Therefore, as the specialists of the oral and maxillofacial surgery in the field of dentistry, we suggest a new policy that the preoperative lab must be performed routinely before extraction of the third molar. Methods: This study is based on 1,096 patients who have been managed with third molar extractions, from March 2008 to September 2011 by a single surgeon. The preoperative lab, including complete blood count, coagulation panel, chemistry and serology, was performed before any surgical procedures. The results were informed to the patients regardless of their abnormalities, and any abnormalities related to the surgical procedures, such as platelet count and coagulation factors, were checked and corrected safely. Results: Through the preoperative blood test, systemic diseases that the patients had not recognized before, such as anemia, leukopenia, fatty liver and chronic renal disease, were identified. Patients with acute or chronic leukemia, Hepatitis B, and HIV positive, were also detected as a small number. Also, the possibilities of the cross-infection between dentists and patients or between patients and patients, and any other emergency situations can be prevented; as well as the public health condition can be improved, too. The patients were satisfied with low cost preventive blood test and high quality of medical services. Conclusion: Therefore, routine medical lab testing, including history taking are needed before an office-based minor surgery, such as third molar extractions, and these results were suggested as a new policy in the field of dentistry.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.5
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• pp.201-206
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• 2014

Purpose: To establish management protocol for mandibular angle fracture, we describe pertinent factors including cause, impacted third molar and recent treatment tendency. Methods: We examined the records of 62 patients who had unilateral mandibular angle fracture. Sixty patients who had open reduction surgery were examined at postoperative weeks 1, 4, 8, 12, and 28. Results: Left mandibular angle fracture is frequent in younger males. Presence of the mandibular third molar can increase fracture risk. Because of attached muscle, favorable fractures occurred primarily in the mandibular angle area. Conclusion: Extracting the mandibular third molar can prevent angle fractures, and open reduction with only one plate adaptation is generally the proper treatment method for mandibular angle fracture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.1
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• pp.57-61
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• 2010

In the presence of acute pericoronitis of mandilbular third molar, antibiotic therapy and early incision and drainage are the method of choice, followed by definitive surgical extraction of the tooth as soon as it becomes subacute. If excision of the overlying tissues is decided on, it should be done adequately. All overlying tissues must be throughly excised, and the crown portion of the unerupted tooth should be completely exposed. After excision has been completed, the wound should be managed with a surgical dressing. This should be allowed to remain approximately 7 days. And then, surgical extraction of the impacted mandibular third molar can be done usually. In this operation, there are many complications, such as, postoperative bleeding, infection, trismus, dysphasia and paresthesia. The surgeon are discredited and medicolegal problem may be occurred in the presence of many distressed complications. Therefore, the relatively nonsurgical treatment is the method of choice. So, authors selected the conservative treatment methods of incision and drainage, primary endodontic drainage, operculectomy without surgical extraction of the mandibular third molars. The results were more favorable without the postoperative complication in Wonju old offender prison.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.207-213
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• 1998

Purpose : This study attempted to relate the incidence of fractures at the mandibular angle with the presence and state of eruption of lower third molars, and to find out the real risk factors for angle fractures in the states of lower third molars. Materials and Methods : Medical records and radiographs of 395 patients with mandibular fractures were retrospectively reviewed. The presence and states of third molars were assessed for each patients and related to the occurrence of angle and other mandibular fractures. Results : Of 395 patients with mandibular fractures, 142 had angle fractures. The incidence of angle fractures was found to be significantly greater when partial erupted lower third molars were present and it had a definite role for risk factors for angle fractures. But there were no clear relationship between the incidence of angle fracrtures and states of without, fully erupted lower third molars. Furthermore, the states of patial and unerupted lower third molar had an effect on bony segment displacement. Conclusions : This study provides clinical evidence to suggest that patial erupted third molar teeth weaken the mandibular angle both quantitatively and qualitatively.