Pathological Mandible Fracture Resulting from Osteomyelitis after Third Molar Removal: A Case Study

The study aimed to report a case of late mandibular fracture after osteomyelitis associated with post-extraction trauma of an impacted third molar.

A male patient, 48 years old, sought oral and maxillofacial surgery service after 2 months of extraction with edema on the left side of the face, limited mouth opening, and spontaneous pain. The tomographic examination showed an area of bone resorption at a mandibular angle starting from the alveolus region of the tooth 38. Associating the clinical and imaging characteristics, the diagnosis of osteomyelitis was established. The patient became well due to the drug treatment and did not present any more complaints. Within 12 months after the extraction, the patient returned to the service with a new increase in volume, in the posterior region of the mandible, with mandibular mobility under manipulation, as well as signs of infection. A new CT showed the presence of a pathological fracture in the region, requiring a surgical approach for local debridement and fracture repair with the use of a reconstruction plate.

The case presented is an uncommon late postoperative complication after third molar extraction, which demonstrates the importance of monitoring the patient with osteomyelitis, in order to avoid worsening bone involvement and consequent pathological fracture.