J Oral Maxillofac Surg

69:1301-1303, 2011

First Report of Accidental Displacement

of Mandibular Third Molar Into
Infratemporal Space
Reza Shahakbari,* Hamed Mortazavi, and Majid Eshghpour
One of the most common procedures in the dental
office is surgical removal of the maxillary or mandibular
third molars.1 Of the complications associated with
third molar extraction, the most commonly mentioned
have been dysesthesia, alveolar osteitis, infection, hemorrhage, fracture of the mandible, and damage to the
adjacent teeth. Accidental displacement of the fractured
roots or teeth into the submandibular, pterygomandibular, and sublingual spaces is a less common complication.2,3 One of the very rare occurrences during mandibular third molar extraction is displacement of the
tooth into the infratemporal space, such as reported in
the present study. A review of the published data revealed little information on the incidence, cause, and
management of displaced tooth and root fragments.2

Case Report
A 23-year-old female patient was referred from her general practitioner to the clinic of oral and maxillofacial surgery of the Mashhad Dental School with a complaint of
limited mouth opening and pain in the left temporal area
after surgical extraction of the mandibular third molar 1
week prior from the left temporal area. The intraoral clinical
examination revealed tissue damage in the left temporal
site. She had a mouth opening of about 15 mm, making it
difficult to perform intraoral examinations or take photographs. A panoramic radiograph suggested the presence of
a tooth apparently near the left coronoid process (Fig 1).
This resulted in a decreased coronoid process range of
motion and maximal mouth opening. The tooth socket
could be seen in the left side of the orthopantomogram

*Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Medical Sciences Mashhad Dental School, Mashhad, Iran.
Assistant Professor, Department of Oral Medicine, University of
Medical Sciences Hamadan Dental School, Hamadan, Iran.
Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Medical Sciences Mashhad Dental School, Mashhad, Iran.
Address correspondence and reprint requests to Dr Mortazavi:
Department of Oral Medicine, University of Medical Sciences Hamadan Dental School, Next to Mardom Park, Hamada, Iran; e-mail:
Mortazavi@umsha.ac.ir
2011 American Association of Oral and Maxillofacial Surgeons

0278-2391/11/6905-0019$36.00/0
doi:10.1016/j.joms.2010.06.215

(OPG) (Fig 1). The presence of the tooth was clearly revealed, adjacent to the coronoid on the patients computed
tomography scan, especially the 3-dimensional computed
tomography scan (Figs 2, 3). Initially, physiotherapy was
conducted for 10 days, to rectify the limitation in mouth
opening if it had been caused by factors other than the
mechanical obstacle of the tooth adjacent to the coronoid.
However, after physiotherapy, no change in the mouth
opening had occurred. The removal of the tooth was attempted with the patient under local anesthesia 20 days
after the initial operation. Access was achieved by a high
ramus incision, similar to a coronoidectomy incision, and
the tooth was removed. Immediately after surgery, the extent of mouth opening had increased. At 1 week after
removing the tooth, her maximal mouth opening was 40
mm. At present, the patient has had no complaints.

Discussion
The incidence of complications associated with surgical removal of the third molar has been moderate
(around 10%). However, trained experienced surgeons have had a lower incidence of complication
than general dentists.3 Fenestration of alveolar bone, a
poor selection of surgical methods, and incorrect use
of an instrument could be some factors resulting in
accidental displacement of a tooth into the anatomic
spaces. Uncontrolled force during the use of elevators
has been reported as the most usual cause of these
complications.2,3 In the present case, the computed
tomography findings showed damage to the lingual
cortex that might have been related to displacement
of the tooth into the infratemporal space. However,
because this entity is very rare, we could not explain
the actual cause of the tooth displacement into the
infratemporal space. The infratemporal space is at the
intersection of the deep temporal space superiorly
and the pterygomandibular space inferiorly. Infections of the infratemporal spaces are most often associated with the contiguous spaces, specifically the
buccal, pterygomandibular, deep temporal, lateral
pharyngeal, and parotid spaces.4 A review of the published data showed that all dislodged teeth into the
infratemporal space were maxillary third molars. We
could not find a case of mandibular third molar having
been displaced into the infratemporal space. The accepted treatment is removal of the displaced teeth or
root fragments to prevent future infection.3 Therefore, patients must be urgently referred to a maxillofacial surgeon after the administration of prophylactic

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ACCIDENTAL DISPLACEMENT OF MANDIBULAR THIRD MOLAR

FIGURE 1. OPG suggesting tooth displaced into infratemporal space and its socket.
Shahakbari et al. Accidental Displacement of Mandibular Third Molar. J Oral Maxillofac Surg 2011.

FIGURE 2. Computed tomography scan showing displaced tooth and damaged lingual cortex in left side of mandible.
Shahakbari et al. Accidental Displacement of Mandibular Third Molar. J Oral Maxillofac Surg 2011.

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SHAHAKBARI ET AL

FIGURE 3. Three-dimensional computed tomography scan showing presence of tooth in infratemporal space near coronoid process
region.
Shahakbari et al. Accidental Displacement of Mandibular Third Molar. J Oral Maxillofac Surg 2011.

antibiotics.5 In conclusion, good selection of the surgical method and the correct use of instruments are
recommended.

References
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hand piece bur during mandibular third molar surgery: A case report.
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2. Tumuluri V, Punnia-Moorty A: Displacement of a mandibular

third molar root fragment into the pterygomandibular space.
Austra Dent J 47:68, 2002
3. Sverzut CE, Trivellato AE, Defigueiredolopes LM, et al: Accidental displacement of impacted maxillary third molar: A case report. Braz Dent J 16:167, 2005
4. Fonseca RJ, Williams TP, Stewart JC: Oral and Maxillofacial
Surgery. Philadelphia, WB Saunders, 2000
5. Durmus E, Dolanmaz D, Kucukkolbsi H, et al: Accidental displacement of impacted maxillary and mandibular third molar.
Quintessence Int 35:375, 2004