Battisti Andrea, Priore Paolo, Giovannetti Filippo, Barbera Giorgio, D'Alessandro Francesco, Valentini Valentino
Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
J Craniofac Surg. 2017 Oct;28(7):1784-1785. doi: 10.1097/SCS.0000000000003628.
Removal of impacted third maxillary molar is frequently carried out without difficulties and low rate of intraoperative complications. The rare and particularly challenger to manage it is the third molar dislocation into the infratemporal fossa (IF). In this clinical report, the authors present their solution to manage and resolve this particular complication.
A 28-year-old woman was referred to the emergency rescue unit of the authors' hospital by her dentistry, after the attempt to extract the left impacted maxillary third molar. During the procedure the tooth accidentally dislodged and was lost sight of it. The patient had significant mouth-opening limitation, omolateral mid face swelling and pain. Computer tomography was immediately performed to determine the exact position of the tooth, showing the dental element dislocated into the IF.
Considering all of possible complications the best surgical option must guarantee a direct approach and a constant eye contact of the tooth, even in case of further displacement during the procedure, and allow early surgery. The authors used an endoscopic transoral approach through the preexisted access and solved all the issues reducing morbidity.
Removing tooth from the IF could be burdened by serious risk of bleeding and/or nerve injury. The endoscopic approach provides direct view of the IF reducing morbidity.
上颌第三磨牙阻生拔除术通常操作顺利，术中并发症发生率低。罕见且特别具有挑战性的情况是第三磨牙脱位至颞下窝（IF）。在本临床报告中，作者介绍了他们处理和解决这一特殊并发症的方法。
一名28岁女性在尝试拔除左侧上颌阻生第三磨牙后，被其牙医转诊至作者所在医院的急救单元。手术过程中，牙齿意外脱位且不见踪影。患者有明显的张口受限、同侧中面部肿胀和疼痛。立即进行计算机断层扫描以确定牙齿的确切位置，显示牙齿脱位至颞下窝。
考虑到所有可能的并发症，最佳手术方案必须保证直接入路并能持续直视牙齿，即使在手术过程中牙齿进一步移位的情况下，且要允许早期手术。作者通过预先存在的通道采用内镜经口入路，解决了所有问题并降低了发病率。
从颞下窝取出牙齿可能面临出血和/或神经损伤的严重风险。内镜入路可直接观察颞下窝，降低发病率。
