Exodontia.Info
Fractured Upper / Lower Jaw
secondary to Tooth Removal
Incidence: 2 - 4% (including alveolar and lingual plate
fractures, so the incidence of actual fractures of the upper
and lower jaws is likely to be much less).

This is probably the most feared of all complications
following
Minor Oral Surgery and like the majority of them
is largely preventable.  It is a recognised complication of
lower wisdom tooth removal and should be listed as such
on a routine consent form.

Fracture of the mandible / lower jaw is a very unpleasant
but fortunately rare complication that is associated almost
exclusively with the extraction of impacted lower
wisdom
teeth.

There are a number of predisposing conditions, such as:

  • use of excessive force with the dental elevator, when
    an adequate pathway for removal of the impacted
    tooth has not been created
  • mandibular atrophy (reduced height and width of jaw)
  • deeply impacted tooth
  • a tooth with firm anchorage
  • extensive œdentulous (toothless) regions
  • an ankylosed (fusion of tooth with surrounding bony
    socket) tooth
  • osteoporosis and
  • the presence of associated pathology such as a cyst
    (dentigeous cyst) or tumour (ameloblastoma).

When a fracture occurs during the extraction, the tooth
must be removed before any other procedure is carried
out, in order to avoid infection along the line of the fracture.

The fracture must be repaired if necessary.  If the operator
is unable to do this, they must arrange an immediate
referral.

Afterwards, depending on the case, stabilisation by way of
inter-maxillary fixation or rigid internal fixation of the jaw
segments is applied for 4 – 6 weeks and broad-spectrum
antibiotics are administered.  Patients should be advised to
consume a soft diet for several weeks and to return
immediately if they become aware of any abnormalities in
the jaw.
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