Intraorbital abscess: a rare complication after maxillary molar extraction

BACKGROUND: The orbit is prone to being affected by an odontogenous infection, owing to its anatomical proximity to the maxillary sinus. A possible reason for an ophthalmic manifestation of a dental abscess is extraction of an acutely inflamed tooth. CASE DESCRIPTION: The authors describe the treatment of a man who had painful swelling and redness in the area of his right eye after having a maxillary molar extracted a few days previous. A general dentist referred the patient to the clinic after he began to experience a progressive deterioration of vision of his right eye. Emergency surgical intervention prevented impending loss of vision, and subsequent healing was uneventful. CLINICAL IMPLICATIONS: To avoid serious complications, clinicians should not perform a tooth extraction when the patient is in the acute stage of a maxillary sinus infection. Appropriate diagnostic imaging and profound evaluation of the clinical state play major roles in managing the treatment of patients with inflammatory processes that involve the oral and paraoral regions.     

Transient diplopia with ipsilateral abducent nerve palsy and ptosis following a maxillary local anesthetic injection

Background

The posterior superior alveolar (PSA) nerve block is commonly used in dentistry for treatment of the maxillary molars. Although this procedure is associated with many complications, ocular complications have been rarely reported.

Case report

This report details an iatrogenic paresis of the abducent nerve and partial palsy of the oculomotor nerve leading to diplopia, strabismus and ptosis following a PSA nerve block and extraction of maxillary right second molar. The patient was treated symptomatically, and the recovery was uneventful. Relevant anatomical pathways with review of literature are discussed.

Discussion

Although rare, the dentist should be aware of these complications to avoid being perplexed by this unexpected circumstance, thus adversely affecting the doctor–patient trust.     

An occlusal and cephalometric analysis of maxillary first and second premolar extraction effects

The purpose of this study was to examine dimensional changes in the maxillary arch following the extractions of maxillary first or second premolars. Pre- and posttreatment records of 71 patients treated by one experienced orthodontist were randomly selected from completed premolar extraction cases. Forty-five patients involved the extraction of maxillary first premolars; of these, 15 also had extractions of mandibular first premolars and 30 had extractions of mandibular second premolars. Twenty-six patients involved the extraction of maxillary second premolars, and all of these also had extractions of mandibular second premolars. Pretreatment factors that seemed to suggest a basis for the extraction choice in this sample included incisal overjet, molar relationship, and maxillary incisor protrusion. Mean reductions with treatment in the anteroposterior arch dimension were similar within all premolar extraction groups. There was evidence of greater mean maxillary intermolar-width reduction following the extractions of maxillary second premolars than following extractions of maxillary first premolars. Greater mean maxillary incisor retraction was found in the maxillary first premolar extraction group than in the maxillary second premolar group. A wide range of individual variation in incisor and molar changes did, however, accompany treatment involving both maxillary premolar extraction sequences.     

Class II correction with the modified sagittal appliance and maxillary second molar extraction

The aim of this article is to describe the clinical use of the removable sagittal appliance combined with the use of a J-hook headgear. This technique was used to distalize the buccal segments following maxillary second molar extraction in the treatment of a Class II patient with labially positioned maxillary canines. The sagittal appliance was used full-time and the headgear was worn 10 to 12 hours per day. This proved to be an effective method for distalizing the maxillary buccal teeth without flaring of the anterior teeth.     

Infratemporal and submasseteric infection following extraction of a non-infected maxillary third molar

A case is described where an otherwise fit young female patient developed a large submasseteric abscess following the uneventful extraction of a non-infected maxillary third molar under local anaesthesia with intravenous sedation. This report highlights the difficulty of clinical diagnosis especially in the early stages of the infection. This case also demonstrates the imaging modalities used to confirm the diagnosis. It is likely that the infection in this case arose in an infratemporal fossa haematoma resulting from reactionary haemorrhage. Careful injection of local anaesthetic with aspiration may prevent this complication arising. This is the first reported case of a submasseteric abscess associated with the extraction of a clinically non-infected maxillary third molar.     

The vertical dimension: the "low-angle" patient

The patient who has a diminished anterior facial height and excess posterior facial height must be treated with a "different" diagnosis and treatment plan. The mandibular incisors must be left in their pretreatment positions--or facial balance will be compromised. They must not be proclined to eliminate crowding or to level a curve of Spee. The three most common diagnostic "schemes" for these patients are: (1) third molar extraction; (2) maxillary first premolar and mandibular third molar extraction; and (3) maxillary first premolar and mandibular second premolar extraction. This article will attempt to explain why certain diagnostic decisions are made. Case reports are used to illustrate the three most common treatment plans.     

Case challenge: the case of the missing root tip

A 43-year old female had her left maxillary first molar removed by her dentist. Upon examining the tooth following the extraction, he discovered the distobuccal root was fractured. Inspection of the extraction site revealed the missing root remained in its alveolus. When attempts were made to remove the root, it suddenly disappeared. To our knowledge, no further efforts were made to locate the root. In the ensuing weeks, the patient's dentist inserted a three-unit bridge to fill the space created by the removal of the first molar. Two months after the extraction, the patient was referred to the Department of Oral Radiology at the University of Lund, Sweden, with a request for help in locating the lost root.     

Maxillary impacted canine with congenitally absent premolars

Multiple treatment options are available to patients who have impacted canines in addition to congenitally absent premolars. Management options for impacted maxillary canines can include (1) continued observation, (2) extraction of the primary canine to aid spontaneous eruption, (3) uncovering and bonding of the impacted tooth and its eruption using orthodontic traction, (4) autotransplantation, and (5) extraction followed by prosthetic replacement. The options for the treatment of missing premolars can include the following: (1) maintaining the primary molars, (2) spontaneous space closure after early extraction of the primary molar, (3) autotransplantation, (4) prosthetic replacement, and (5) orthodontic space closure. In this case report, treatment of a patient with an impacted maxillary canine and agenesis of three second premolars will be presented.     

Zygomatic bone graft for oral-antral communication closure and implant placement

The roots of molar and premolar maxillary teeth are often very close to the floor of the maxillary sinus. As a result, extraction of these teeth can leave an oral-antral communication or lead to a fistula that requires treatment. A woman with an oral-antral communication secondary to extraction of a maxillary molar is presented. The communication was closed by means of a bone graft harvested from the wall of the sinus (zygomatic bone). After 3 months, 2 dental implants were placed, one in the pterygoid area and the other with parasinusal angulation. Rehabilitation followed in the form of a screw-retained, fixed prosthesis 3 months after implant placement. There have been no complications after 1 year of follow-up. This surgical technique allowed closure of an oral-antral communication produced by molar extraction through placement of a zygomatic bone graft and subsequent placement of 2 dental implants.     

Temporal abscess after third molar extraction in the mandible

Background

Dental infections resulting before or after third molar removal are complications in which the maxillofacial surgeon may have to initiate an earlier management. The severe dental infections resulting before or after this procedure is one of the few life-threatening complications in which the maxillofacial surgeon may have to initiate an earlier management. Infections involving the temporal space are rare and infrequently reported. Infections in this space have also been observed secondary to maxillary sinusitis, maxillary sinus fracture, temporomandibular arthroscopy, and drug injection, although more commonly associated to third molar infections.

Case report

A 22-year-old man had undergone extraction of tooth 38 secondary to pericoronaritis by a general dentist. Physical examination of his face demonstrated severe trismus, pain, and swelling in temporal region. A CT scan showed an inflammatory area into the temporal space. He was started on IV cephalosporin, but the clinical course of the patient was not satisfactory. Incision and drainage were performed from an extraoral and intraoral approach. After discharged, the antibiotic was switched to clindamycin IO 600?mg.

Discussion

The retromaxillary and temporal infections are quite common after maxillary molar extractions but not after mandibular third molar, the spread mechanism of ascension must be involved with the virulence of microorganisms, but more studies are necessary to clarify this occurrence.     

Comparative study of local anesthetic efficacy of 5% tramadol versus 2 %Lignocaine with 1:100,000 adrenaline for extraction of fully erupted maxillary 3rd molars using infiltration anesthesia

IntroductionThe majority of dental procedures need local anesthesia for pain control, and lidocaine/ lignocaine is the most commonly used anesthetic agent in dentistry. Although effective and safest, the anesthetic agent still has some complications. To overcome these many alternatives have been used. Tramadol has been shown to have some local anesthetic (LA) effects when used for infiltration anesthesia in dentistry.MethodsIn the present study, the local anesthetic efficacy of tramadol was compared with 2% lignocaine containing 1: 100,000 adrenaline for the extraction of maxillary fully erupted 3rd molar teeth. The parameters recorded included the onset of action, duration of action, intraoperative pain, post-operative analgesic effect, and incidence of an allergic reaction. A total of 200 patients were randomly divided into two groups. In group A -Each patient received 0.6 ml of 5% tramadol (Tramataj- 50 mg prepared by Taj pharma company) 0.4 ml buccally and 0.2 ml palatally for extraction of maxillary 3rd molar as local infiltration following strict aseptic precaution. In Group B- patients received 0.6 ml of 2% lignocaine containing 1: 100,000 adrenaline buccally and 0.2 ml palatally as infiltrations.ResultsIt was found that 5% tramadol has a local anesthetic efficacy similar to 2% lignocaine with adrenaline but was found to be a comparatively weaker agent.Conclusiontramadol is a valid alternative for performing extractions in normal patients or patients allergic to lidocaine.     

Comparative study of local anesthetic efficacy of 5% tramadol versus 2 %Lignocaine with 1:100,000 adrenaline for extraction of fully erupted maxillary 3rd molars using infiltration anesthesia

IntroductionThe majority of dental procedures need local anesthesia for pain control, and lidocaine/ lignocaine is the most commonly used anesthetic agent in dentistry. Although effective and safest, the anesthetic agent still has some complications. To overcome these many alternatives have been used. Tramadol has been shown to have some local anesthetic (LA) effects when used for infiltration anesthesia in dentistry.MethodsIn the present study, the local anesthetic efficacy of tramadol was compared with 2% lignocaine containing 1: 100,000 adrenaline for the extraction of maxillary fully erupted 3rd molar teeth. The parameters recorded included the onset of action, duration of action, intraoperative pain, post-operative analgesic effect, and incidence of an allergic reaction. A total of 200 patients were randomly divided into two groups. In group A -Each patient received 0.6 ml of 5% tramadol (Tramataj- 50 mg prepared by Taj pharma company) 0.4 ml buccally and 0.2 ml palatally for extraction of maxillary 3rd molar as local infiltration following strict aseptic precaution. In Group B- patients received 0.6 ml of 2% lignocaine containing 1: 100,000 adrenaline buccally and 0.2 ml palatally as infiltrations.ResultsIt was found that 5% tramadol has a local anesthetic efficacy similar to 2% lignocaine with adrenaline but was found to be a comparatively weaker agent.Conclusiontramadol is a valid alternative for performing extractions in normal patients or patients allergic to lidocaine.     

Evaluation of Post-operative Complication Rate of Le Fort I Osteotomy: A Retrospective and Prospective Study

Le Fort I osteotomy has become a routine procedure in elective orthognathic surgery. This procedure is often associated with significant but rare post-operative complications. The study was conducted to evaluate the rate of post-operative complications following conventional Le Fort I osteotomy. Twenty-five healthy adult patients who had to undergo Le Fort I osteotomy without segmentalization of maxilla were included in the study based on indications of surgery. All the patients were followed up for a period of 6 months post-operatively to assess the rate of various post-operative complications such as neurosensory deficit, pulpal sensibility, maxillary sinusitis, vascular complications, aseptic necrosis, unfavourable fractures, ophthalmic complications and instability or non-union of maxilla, etc. The results of our study showed a post-operative complications rate of 4 %. Neurosensory deficit and loss of tooth sensibility were the most common findings during patient evaluation at varying follow-up periods while one patient presented with signs and symptoms of maxillary sinusitis post-operatively. Neurosensory as well as sinusitis recovery took place in almost all the patients within 6 months. It was concluded that thorough understanding of pathophysiological aspects of various complications, careful assessment, treatment planning and the use of proper surgical technique as well as instrumentation may help in further reducing the complication rate.     

An evaluation of combination second molar extraction and functional appliance therapy

The purpose of this study was to examine the results of a treatment regimen involving the extraction of four second molars followed by a combination of sagittal, Bionator, and fixed appliance therapy. The pretreatment and posttreatment cephalometric and dental cast records of 30 consecutively treated Class II, Division 1 cases were evaluated. Results showed that the Class II skeletal correction was achieved by a "headgear" effect inhibiting maxillary growth in conjunction with normal forward mandibular growth. No significant distal bodily movement or tipping of either maxillary or mandibular first molars was found. Significant increases were seen in maxillary arch length, maxillary intercanine and intermolar width, and mandibular intermolar width as a result of treatment. Maxillary third molar position tended to improve following second molar extraction; mandibular third molar changes were more variable.     

Subperiosteal abscess of the orbit: an unusual complication of the third molar surgery

Few procedures in oral surgery show severe complications with the potential to result in life-threatening problems. Subperiosteal orbital abscess is an extremely rare but transcendent complication arising spontaneously or after dental surgery. This report describes a case of subperiosteal abscess of the orbit in a 57-year-old man that occurred following the uneventful extraction of the left maxillary third molar. In the emergency department, proptosis and extraocular muscle dysfunction were marked but no decrease in visual acuity was observed. Echography, computed tomography scan, and magnetic resonance imaging allowed distinction from other types of orbital inflammation. Surgical drainage confirmed the diagnosis. In this patient, orbital abscess was probably caused by extension of the infection to the pterygopalatine and infratemporal regions progressing next to the inferior orbital fissure. This report highlights the difficulty in the clinical diagnosis of this complication.     

The migration pathway of an extracted maxillary third molar into the buccal fat pad

The migration of the maxillary third molar is one of the most critical complications that can occur during extraction, and the most frequent site of migration is the maxillary sinus. We herein report an extremely rare case in which the migrated maxillary third molar became displaced into the buccal fat pad. The pathway of migration from the original site of the tooth into the buccal space is therefore considered from the anatomical perspective in this paper.     

Cranial nerve injury after Le Fort I osteotomy

A Le Fort I osteotomy is widely used to correct dentofacial deformity because it is a safe and reliable surgical method. Although rare, various complications have been reported in relation to pterygomaxillary separation. Cranial nerve damage is one of the serious complications that can occur after Le Fort I osteotomy. In this report, a 19-year-old man with unilateral cleft lip and palate underwent surgery to correct maxillary hypoplasia, asymmetry and mandibular prognathism. After the Le Fort I maxillary osteotomy, the patient showed multiple cranial nerve damage; an impairment of outward movement of the eye (abducens nerve), decreased vision (optic nerve), and paraesthesia of the frontal and upper cheek area (ophthalmic and maxillary nerve). The damage to the cranial nerve was related to an unexpected sphenoid bone fracture and subsequent trauma in the cavernous sinus during the pterygomaxillary osteotomy.     

Three-dimensional space changes after premature loss of a maxillary primary first molar

Background.  A space maintainer is generally preferred when a primary first molar is lost before or during active eruption of the first permanent molars in order to prevent space loss. However, controversy prevails regarding the space loss after eruption of the permanent first molars.
Aim.  The purpose of this study was to examine spatial changes subsequent to premature loss of a maxillary primary first molar after the eruption of the permanent first molars.
Design.  Thirteen children, five girls and eight boys, expecting premature extraction of a maxillary primary first molar because of caries and/or failed pulp therapy, were selected. Spatial changes were investigated using a three-dimensional laser scanner by comparing the primary molar space, arch width, arch length, and arch perimeter before and after the extraction of a maxillary primary first molar. Also, the inclination and angulation changes in the maxillary primary canines, primary second molars, and permanent first molars adjacent to the extraction site were investigated before and after the extraction of the maxillary primary first molar in order to examine the source of space loss.
Results.  There was no statistically significant space loss on the extraction side compared to the control side ( P  = 0.33). No consistent findings were seen on the inclination and angulation changes on the extraction side.
Conclusions.  The premature loss of a maxillary primary first molar, in cases with class I molar relationship, has limited influence on the space in permanent dentition.     

仅用阿替卡因颊侧浸润麻醉拔除上颌第三磨牙的临床对照研究

目的：评价上颌第三磨牙拔除术中阿替卡因颊侧浸润注射对腭侧软组织的麻醉作用，讨论常规腭侧浸润麻醉注射是否必须。方法：28例拔除双侧上颌第三磨牙患者，每位患者作为其自身对照。对照侧利用盐酸阿替卡因行颊侧浸润麻醉及腭侧浸润麻醉，实验侧仅行颊侧浸润麻醉。注射3min后常规方法拔除患牙。利用100mm直观模拟标度尺（VAS）及问卷调查获得患者拔牙时的痛觉数据。结果：实验侧和对照侧的疼痛感觉（VAS值）没有显著性差异（P〉0．05），拔牙过程中的疼痛均可接受。结论：仅用阿替卡因颊侧浸润麻醉可顺利拔除上颌第三磨牙，无需常规腭侧浸润麻醉，从而避免腭侧注射的疼痛不适。     

应用CBCT回顾分析牙源性上颌窦病变

［摘要］ 目的 通过回顾CBCT资料评估牙源性上颌窦炎的影像学表现及最易引起牙源性上颌窦炎的牙位。方法 将500例CBCT资料分为正常上颌窦、牙源性上颌窦病变、非牙源性上颌窦病变和无法判断来源的上颌窦病变,并进行统计学分析。结果 牙源性上颌窦炎的影像学表现是发生龋病、不良修复体的上颌后牙或对应牙位有未愈合的拔牙创,无论其是否伴有根尖周病变,该病变牙相应上颌窦底黏膜会呈局部隆突性增厚影像。牙源性上颌窦炎发病率占常人的12.4%,占上颌窦病变病人的48.6%。上颌第一磨牙最易引起牙源性上颌窦炎。发生上颌窦炎,即黏膜增厚>2 mm的病例中,黏膜平均增厚(6.11±4.43) mm。结论 牙源性因素占上颌窦炎发病因素的一半;上颌第一磨牙最易引起牙源性上颌窦炎;CBCT能清晰反映上颌窦的解剖解构及上颌窦炎所引起的变化。