The complications of intraalveolar extraction of maxillary teeth that are documented include displacement of the teeth or roots into the maxillary sinus, fracture of the maxillary alveolus and fracture of the maxillary tuberosity, oroantral communication, and intraorbital hematoma. Wound dehiscence, postoperative pain and hemorrhage showed a medium into maxillary antrumadjacent tissue spaces, infection and fracture of maxillary tuberosity were comparatively rare complications. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. Additionally, the fracture components may result in.
Large fractures of the maxillary tuberosity should be viewed as a grave complication. Answer fractures of greater tuberosity can occur in isolation or in combination with anterior dislocation of the shoulder. Complications occur during dental extraction and their. The maxillary tuberosity is important for the construction of a stable and retentive maxillary denture. At the lower part of the infratemporal surface of the maxilla is a rounded eminence, the maxillary tuberosity, especially prominent after the growth of the wisdom tooth. From the foregoing, it can be seen that tuberosity fracture may occur during dental extractions and that careful preoperative assessment is necessary to avoid. A correct preoperative radiographic interpretation, coupled with the anatomical knowledge of the structures involved, is essential to prevent such complications. Tuberosity repair for fractures shoulderdoc by prof. The eventual removal of the fragment under general anaesthetic required. The maxillary tuberosity can fracture during extraction of a molar tooth. This article presents a case of large fracture of maxillary tuberosity during extraction of first maxillary molar tooth and its conservative treatment outcomes.
These fractures occur most often in the anterior or premolar regions of jaws in youth and adults 5. The le fort classification system attempts to distinguish according to. Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. From the prosthetic point of view, anatomic area of maxillary tuberosity is especially. Oroantral fistulae and fractured tuberosities british. Greater tuberosity fracture east sussex healthcare nhs trust. The tcr has been reported extensively in various maxillofacial surgeries, including craniomaxillofacial operations, 50,99 temporomandibular joint arthroscopies, 100 maxillary tuberosity cuttings, 101 le fort i osteotomies, 102 nasal fracture reconstructions, 103 zygomatic arch fracture elevations, 104 and midface disimpactions. We present a case of lifethreatening haemorrhage complicating a tuberosity fracture during simple. Usually xrays are taken to diagnose fractures of the mandible or only. Maxillary tuberosity fractures during molar teeth extraction commonly occur in dental practice.
When the maxillary sinus is enlarged between the roots of upper molars and the maxillary tuberosity, these. You have sustained an undisplaced fracture to your greater tuberosity of your shoulder. Complications occur during dental extraction and their management 1. Browti,1 considering complications of oral surgical procedures, believed that if fracture of the maxillary tuberosity occurred the, segment should be removed surgically en bloc and that tlie defect should be carefully sutured. Should be fixed by transosseous wiring or bone plating. It is during this immobilisation period most of the complication develops and most common of them is joint stiffness and pain. Pdf considerations of maxillary tuberosity fractures. In a modified blind surgical technique, the tooth is removed without the fractured bone. They are the second most common facial bone fracture after nasal bone fractures pathology.
Diagnostic imaging in oral and maxillofacial pathology. The maxillary tuberosity is especially important for the stability of upper dentures and may cause a mouthsinus comminication oroantral communication. If the maxillary tuberosity fracture nevertheless happens, the dentist must diagnose the complication and inform the patient about it. Maxillary tuberosity fracture associated with first molar. Management of maxillary sinus perforation following tooth. Iatrogenic fracture of the maxillary tuberosity a case report. Zygomaticomaxillary complex fracture radiology reference. How to manage tuberosity fracture during extraction jcda. It can be fractured during extraction of maxillary molars which. Pdf maxillary tuberosity fracture associated with first molar. Maxillary tuberosity fractures during molar teeth extraction can occur commonly in dental practice. In this study we observed that the maxillary artery groove has a variable location in the superior and lateral edge of the maxillary tuberosity, with an average distance from sphenoidal tubercle of 10.
Nasal fractures may be associated with deformity of the nose, as well as swelling. Pdf multiple maxillary tuberosity exostosis khurshid a. An alternative method abstract the maxillary tuberosity can fracture during extraction of a molar tooth. Complication of extraction ranges from periodontal injury to fracture of jaw in the mandible and fracture of tuberosity and oroantral communication in the maxilla. Concerning extraction of maxillary molars, fracture of the maxillary tuberosity is among the most delicate.
The maxillary tuberosity is tough and also is protected by hard periodontal tissue. Review article surgical treatment of displaced greater. Multiple intra oral bony tori and exostosis have often been reported in the literature to occur in the mandible. Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues such symptoms can occur in the absence of fractures as well. Fracture of the maxillary tuberosity is a potential sequela of removal of maxillary posterior teeth. Extraction management of a fractured maxillary tuberosity. The majority more than 95% are either nondisplaced or minimally displaced and can be treated without surgery.
The maxillary tuberosity is a big, curved space on the outside of the maxillary bones or the bone fragments of the upper jaw in the region of the back teeth, the wisdom teeth in the back of the oral cavity. Tuberosity repair for hemiarthroplasty for proximal humeral fractures. Tuberosity definition of tuberosity by the free dictionary. On rare occasions, such a complication can result in torrential haemorrhage due to the close proximity of significant vessels to the area. The the fracture of a large portion of bone in the area is a situation is especially important for the stability maxillary maxillary of upper dentures and may cause a mouthsinus comminication oroantral communication. Trauma to adjacent tooth soft tissue injuries fracture of the alveolar process fracture of maxillary tuberosity fracture of the mandible broken instruments in tissues dislocation of tmj subcutaneous or submucosal emphysema hemorrhage displacement of impacted tooth, root, or root tip into maxillary. Surgical treatment of displaced greater tuberosity fractures of the humerus. Delivery of the tooth and bone fragment under local anaesthesia was unable to be achieved because of pain, brisk bleeding and tethering by the lateral and medial pterygoid muscles. Fractures of the maxillary tuberosity occurring during tooth extraction. Abstract maxillary tuberosity fracture is a potential complication of routine exodontia of posterior maxillary teeth. Introduction 2nd largest bone of face 2 maxillae forms whole of upper jaw each maxilla contributes in formation of 1.
Maxillary tuberosity definition of maxillary tuberosity. We report a case in which the extraction of an upper second molar was complicated by a maxillary tuberosity fracture. Meanwhile, maxilla in maxillary is derived from the latin word mala, which means cheek. Often, a small fragment of bone is able to be carefully dissected from its periosteum and delivered with the tooth. Maxillary tuberosity an overview sciencedirect topics. A maxillary tuberosity is thought to be more predisposed to fracture if the maxillary sinus has enlarged between the teeth and into the tuberosity. Le fort fracture classification radiology reference. Shoulder impingement and treatment after fracture feat. The most essential part of shoulder hemiarthroplasty for fractures is the repair of the greater and lesser tuberosities around the prosthesis and to the humeral shaft. Diagnostic imaging in oral and maxillofacial pathology 217 2.
Fractures of the jaw and midface injuries and poisoning. The fracture line extends from the piriform aperture through the zygomaticoalveolar crest to the maxillary tuberosity and into the pterygopalatine fossa. Maxillary tuberosity fracture and subconjunctival hemorrhage. Maxillary tuberosity fracture associated with first molar extraction. A, the avulsion type involves a smaller fragment with a horizontal fracture line.
Fractures that extend through a tooth or its socket create an opening into the mouth that can allow bacteria in the mouth to infect the mandible or maxilla. During the extraction, the left maxillary tuberosity fractured and came out along with the tooth. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. B, the depression type involves an inferiorly displaced and impacted greater tuberosity. The dentist packed and sutured the site and referred the patient to the maxillofacial department of the local hospital, where antibiotics were prescribed but no further treatment was required. If there is a large maxillary tuberosity fracture, the aim is to salvage the fractured bone in place and to provide the best possible environment for healing. Fracture of the maxillary tuberosity sciencedirect. The maxilla is separated from the facial skull in a horizontal plane above the teeth apices and the hard palate. This normally takes between 612 weeks to unite heal. If a small bony fragment is affected, the extraction of the tooth and tuberosity continues.
The latin word macerare also means to chew, and this potentially was the foundation for the term maxilla as well. In case of extraction of maxillary molars if maxil lary tuberosity also fractures, the fractured bone. Fracture of the maxillary tuberosity semantic scholar. A doctors examination can usually determine if the jaw is broken. Should be replaced and retained by primary suturing of soft tissues. In the maxillary arch the tori has been reported to occur usually in the midline and has been termed as torus palatinus. The fracture of a large portion of bone in the maxillary tuberosity area is a situation of special concern.
Pdf maxillary tuberosity fractures during molar teeth extraction can occur commonly in dental practice. The etiologic factors responsible for fractured maxillary tuberosity during extraction of upper molars are a large maxillary sinus. The maxillary tuberosity is especially important for the stability of maxillary denture. Also, it was observed that the fracture of tooth is the most common complication, followed by trismus, fracture of cortical plates and dry socket. The majority of maxillary molar teeth to be removed will not be related to the maxillary sinus or predispose to maxillary tuberosity fracture and can be safely removed by the general dentist in. Considerations of maxillary tuberosity fractures during. It is seen in the radiograph as a radiolucent im age which is known as burnout effect. Oral surg oral med oral pathol the fractured maxillary tuberosity. After the fracture the shoulder joint is immobilized in sling for roughly one to one and half month. C, the split type is a large fragment characterized by a vertical fracture line. If there is a large maxillary tuberosity fracture, the aim is to salvage the fractured. The maxillary tuberosity is especially important for the stability of upper dentures and may cause oroantral communication. Should be replaced and allowed to heal by secondary intention. Fracture of a large portion of bone in the maxillary tuberosity area is a situation of special concern.1133 190 45 1152 366 741 841 1071 550 859 1396 1268 1284 195 724 1239 338 429 565 1290 186 975 555 128 1060 1274 948 497 148 440 1488 18 427 692 166 683