PDF: Iatrogenic Fracture of the Lower Jaw: A Rare Complication of Lower Molar Extraction

This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019.

Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033–0.0034%.

The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. 

The position and impaction of the lower third molars were evaluated according to Pell and Gregory’s classification and Winter’s classification. One fracture was left-sided, and 7 fractures were right-sided. 

In 6 cases, Winter’s extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. 

One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.

Extraction of lower permanent molars is a routine surgical procedure. In most cases, the reason for the tooth removal is tooth decay and its complications (pulpitis, apical periodontitis), acute or chronic pericoronitis, less often periodontal disease, and orthodontic treatment. 

However, complications can occur during or after the procedure. The most common non-specific complications of lower molar extractions include alveolar osteitis (alveolitis sicca dolorosa), early or late bleeding after extraction, hematoma, soft tissue contusion, collateral edema, or prolonged healing of the extraction wound. 

Some complications are rather specific, occurring mainly in association with the extraction of lower third molars that are also called wisdom teeth. 

Due to the localization of lower third molars, the surgical procedure may lead to an injury of the neurovascular bundle in the canalis mandibulae manifested by bleeding from the mandibular canal or inferior alveolar nerve damage. 

A rare and specific complication is also an iatrogenic fracture of the lower jaw, which can occur not only during the operation itself but in the period after the operation as well. 

The aim of this work is a retrospective evaluation of the frequency and circumstances of this surgical complication in individuals registered at the Dental Clinic, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové in the years 2006–2019. 

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