Mandibular fractures associated with third molar odontectomy
DOI:
https://doi.org/10.2478/AMB-2025-0077Keywords:
mandibular fracture, odontectomy, third molarAbstract
Background: Intraoperative and postoperative fractures of the mandibular angle are among the most common complications associated with surgical interventions in this region. These fractures may occur intraoperatively or postoperatively, leading to significant patient discomfort and prolonged treatment duration. The aim of this study is to present several cases of intraoperative and postoperative fractures occurring in the mandibular angles after third molar extractions. Results: We report three cases of patients who sustained postoperative mandibular angle fractures following the odontectomy of lower third molars. Factors contributing to this complication were analyzed, along with the treatment methods employed. Intraoperative and postoperative fractures are relatively rare complications. While some fractures occur during surgery, others may develop spontaneously at a later stage due to the weakened structural integrity of the mandible. Certain preventive approaches, such as prophylactic immobilization, have demonstrated positive outcomes; however, they may also increase patient discomfort. Conclusion: Each surgical case should be assessed individually. In cases of significantly elevated fracture risk, prophylactic immobilization may be a reasonable preventive measure.
References
Toffanin A, Zupi A, Cicognini A. Sagittal split osteotomy in removal of impacted third molar. J Oral Maxillofac Surg. 2003;61:638–640.
Sakr K, Farag IA, Zeitoun IM. Review of 509 mandibular fractures treated at the University Hospital, Alexandria, Egypt. Br J Oral Maxillofac Surg 2009; 44: 107–111.
Krimmel M, Reinert S. Mandibular fracture after third molar removal. J Oral Maxillofac Surg 2000; 58: 1110–1112.
Niedzielska I, Kowol I, Sroczynska-Grula A. Iatrogenic injury during extraction of lower molar teeth. Dent Med Probl. 2009; 46: 501–505.
Thorn JJ, Mogeltoft M, Hansen PK. Incidence and aetiological pattern of jaw fractures in Greenland. Int J Oral Maxillofac Surg 1986; 15: 372–379.
Subhashraj K, Ramkumar S, Ravindran C. Pattern of mandibular fractures in Chennas, India. Br J Oral Maxillofac Surg 2008; 46: 126–127.
Libdy MR, Rabello NM, Marques LS, Normando D. The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs. Dental Press J Orthod. 2020;25(4):68-74.
Szücs A, Bujtar P, Sandor GKB, Barabas J. Finite element analysis of the human mandible to assess the effect of removing an impacted third molar. J Can Dent Assoc 2010; 76: a72.
Neelima AM. Textbook of oral maxillofacial surgery, 2nd ed. New Delhi, India: Jaypee Brothers; 2008.
Puyén-Goicochea C, Ortiz-Pizarro M, Blanco-Victorio DJ, Serna-Alarcón V. Factors associated with indication of prophylactic extraction of the lower third molar in orthodontic practice. J Clin Exp Dent. 2024, Mar 1;16(3):e343-e349.
Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofacial Surg 2005; 34: 722–726.
Chrcanovic BR, Custodio ALN. Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature. Oral Maxillofac Surg 2010; 14: 71–80.
Al-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg 2009; 67(4): 856–861.
Contar CM, de Oliveira P, Kanegusuku K, et al. Complications in third molar removal: a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal 2010; 15: e74–78.
Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc. 2007 May;73(4):325.
Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007;19(1):117-28, vii.
Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59(9):1012-7; discussion 1017.
Baqain ZH, Karaky AA, Sawair F, et al. Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study. J Oral Maxillofac Surg. 2008;66(11):2276-83.
Rakhshan V. Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg. 2015;41(2):59-65.
Sands T, Pynn BR, Nenniger S. Third molar surgery: current concepts and controversies. Part 2. Oral Health. 1993;83(5):19, 21-2, 27-30.
Mihaylova Z, Ugrinov R, Aleksiev E, Stanimirov P. RhPDGF – Basic Characteristics and Potential Application in the Oral Surgery – An Overview. Acta Medica Bulgarica, 2020; 47(3), 61-66.
Mihaylova Z, Aleksiev E, Ugrinov R. Denosumab-related osteonecrosis of the jaw in a patient with osteoporosis: case report. International Journal of Medical Science and Clinical Invention. 2018; 5(11): 4154-4156.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 P. Petrov, A. Zheleva, I. Radev, I. Doykova, D. Shopova, A. Georgiev, S. Harizanova, M. Dimova-Gabrovska (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
Journal Acta Medica Bulgarica 
