Mandibular angle fractures during third molar removal: a report of two cases

ABSTRACT Objective: To assess the relationship between impacted mandibular third molar presence and the risk for mandibular angle fracture with the effect of various positions of mandibular third molar and the risk of mandibular angle fracture. Materials and Methods: In the North Indian territory, a total of 289 patients with mandibular angle fractures were studied and evaluated for the possible relationship with impacted third molar on the basis of clinical and panoramic radiographical findings. Results: Results that confirmed the highest risk for mandibular angle fracture was associated with mesioangular angulations (45.42%) followed by vertical (26.34%), distoangular in sequence and least risk was found with bucco-version angulations (2.67%) according to Winter′s classification. Additionally, the highest risk of mandibular angle fracture was reported with partially erupted third molar (47.75%), followed by erupted (23.53%) and unerupted third molar (19.38%). Conclusion: The risk for mandibular angle fracture is not only affected by status of eruption, angulations, position, number of roots present in third molar but also by the distance of mandibular third molar from inferior border of mandible and the percentage of remaining amount of bone at the mandibular angle region.

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Transoral versus extraoral approach for mandibular angle fractures: A comparative study

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.146590 ◽

2014 ◽

Vol 47 (03) ◽

pp. 354-361 ◽

Cited By ~ 3

Author(s):

Sathya Kumar Devireddy ◽

R.V. Kishore Kumar ◽

Rajasekhar Gali ◽

Sridhar Reddy Kanubaddy ◽

Mallikarjuna Rao Dasari ◽

...

Keyword(s):

Masseter Muscle ◽

Third Molar ◽

Fracture Line ◽

Difficulty Level ◽

Mandibular Angle ◽

Group I ◽

Maxillofacial Fractures ◽

Severe Difficulty ◽

Group Ii ◽

Angle Fractures

ABSTRACT Introduction: Mandibular fractures represent approximately two-thirds of all the maxillofacial fractures (nearly 70%) out of which fractures of mandibular angle represent for 26-35%. Aim of the Study: The aim of this study is to compare the transoral and extraoral (submandibular) approaches for fixation of mandibular angle fractures. Objectives of Study: The objectives of the following study are to evaluate ease of accessibility, time taken for the procedure, ease of anatomic reduction and complications. Materials and Methods: A prospective study was carried out in 30 patients reporting to the Department of Oral and Maxillofacial surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh during the period of months from November 2011 to August 2013 who were randomly divided in two groups based on computer generated simple randomization chart. Group I patients underwent transoral reduction and fixation and Group II patients underwent extraoral reduction and fixation. The ease of accessibility was analysed by visual analogue scale by the operating surgeon, time taken from incision to closure with digital clock, difficulty level index of surgeon based on the time taken for the procedure and approach related complications. Results: The ease of accessibility in Group I was good in 53.3% while in Group II patients approached extraorally it was good in 86.7%. Group I patients approached transorally showed a mean of 49.7 min while that of Group II patients approached extraorally showed a mean of 73.4 min. Group I had a minimum difficulty level index in 60%, moderate difficulty level in 33.3% and severe difficulty level in 6.7% while Group II had a minimum and moderate difficulty level in 46.7% and severe difficulty level in 6.7%. There was 1 (6.7%) complication reported in each group. Conclusion: The statistical analysis of this study concludes that fracture line starting anterior to mandibular third molar and ending at anteroinferior border of the insertion of the masseter muscle or posterior body of mandible can be approached transorally. Fracture line starting posterior or distal to the third molar or posterior to the insertion of the masseter muscle to the angle of the mandible or fracture line extending high in the ramus, extraoral approach provides a better choice for reduction and fixation of the fractured segments with restoration of anatomical and functional occlusion.

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Impacted third molar and mandibular angle fractures

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology ◽

10.1016/s1079-2104(96)80320-9 ◽

1996 ◽

Vol 81 (3) ◽

pp. 264 ◽

Cited By ~ 5

Author(s):

Thomas B. Dodson

Keyword(s):

Third Molar ◽

Mandibular Angle ◽

Impacted Third Molar ◽

Angle Fractures

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Lower third molar in the line of mandibular angle fractures treated with stable internal fixation: To remove or retain?

Journal of Oral and Maxillofacial Surgery Medicine and Pathology ◽

10.1016/j.ajoms.2012.05.015 ◽

2013 ◽

Vol 25 (2) ◽

pp. 115-118 ◽

Cited By ~ 3

Author(s):

Pavan M. Patil

Keyword(s):

Internal Fixation ◽

Third Molar ◽

Mandibular Angle ◽

Angle Fractures ◽

Stable Internal Fixation

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125 The Fate of The Third Molar in The Line of a Mandibular Angle Fracture: A Retrospective Study at A Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.533 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Dattani ◽

A Aslam ◽

K McMillan

Keyword(s):

Retrospective Study ◽

Third Molar ◽

Fracture Repair ◽

Queen Elizabeth Hospital ◽

Wisdom Tooth ◽

Mandibular Angle ◽

Tertiary Centre ◽

Mandibular Angle Fracture ◽

Angle Fracture ◽

Angle Fractures

Abstract Aim: To evaluate the risk of complications associated with retaining or extracting an asymptomatic third molar in the line of an angle fracture. Aiming to seek a consensus whether third molars should be extracted or retained during surgical repair of mandibular angle fractures. Method A retrospective study was undertaken at the Queen Elizabeth Hospital, Birmingham. 150 patients across a span of three years underwent open reduction and internal fixation of mandibular angle fractures with third molar involvement. Patients were classified into two groups, tooth retention during angle fracture and tooth removal during angle fracture repair. Hospital records were evaluated to seek the rate of post-operative complications at follow-up Results 162 angle fractures were identified with ipsilateral wisdom teeth present. In 37 cases the wisdom tooth was removed during surgery. 6 complications (16.2%) occurred in this group necessitating a return to theatre. In 125 cases the wisdom tooth was left in-situ. Complications necessitating a return to theatre occurred in 14 cases (11.1%). Conclusions This study indicates that retention of wisdom tooth overall did not significantly increase the risk of complications associated with angle fractures (p = 0.42). Where wisdom tooth pathology was noted its retention was associated with complications requiring a return to theatre (X2=4.40, p = 0.036).

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Correlation of Third Molar Status with Incidence of Condylar and Angle Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0036-1584400 ◽

2016 ◽

Vol 9 (3) ◽

pp. 224-228 ◽

Cited By ~ 4

Author(s):

Suresh Menon ◽

Veerendra Kumar ◽

V. Srihari ◽

Yogitha Priyadarshini

Keyword(s):

Retrospective Study ◽

Third Molar ◽

Third Molars ◽

Positive Relation ◽

Mandibular Angle ◽

The Third ◽

Angle Fractures ◽

Condylar Fractures

The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar and angle fractures in 104 patients treated for these fractures during the period from June 2009 to December 2013. Clinical and radiographic records of these patients were studied to look for the presence and position of third molars and their relation to incidence of condylar or angle fractures. There was a definite positive relation to impacted third molars and increased incidence of angle fractures. The condylar fractures were more commonly seen when the third molars were fully erupted or missing. Third molar impactions predispose to angle fractures and missing or fully erupted third molars predispose to condylar fractures.

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Presence of the Third Molar as a Risk Factor in Mandibular Angle Fractures

Asian Journal of Oral and Maxillofacial Surgery ◽

10.1016/s0915-6992(03)80039-0 ◽

2003 ◽

Vol 15 (3) ◽

pp. 176-180 ◽

Cited By ~ 2

Author(s):

Atsushi Kasamatsu ◽

Toshihide Watanabe ◽

Harusachi Kanazawa

Keyword(s):

Risk Factor ◽

Third Molar ◽

Mandibular Angle ◽

The Third ◽

Angle Fractures

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270 A Retrospective Analysis of The Impaction Status of Mandibular Third Molars as A Risk Factor for Fractures of Angle or Condylar Region of The Mandible

British Journal of Surgery ◽

10.1093/bjs/znab259.612 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Al-Harbawee

Keyword(s):

Third Molar ◽

Class Ii ◽

Class I ◽

Third Molars ◽

Mandibular Angle ◽

Wisdom Teeth ◽

Highly Correlated ◽

Mandibular Third Molars ◽

Angle Fractures ◽

Condylar Fractures

Abstract Background the position and angulation of mandibular third molars have both been found to influence the angle and condylar fractures. Objective: To identify whether there is an association between the depth and angulation of third molar impaction and the relative risk of fracture of the mandibular angle and condyle. Method Four-hundred and eighty-two panoramic dental radiographs were assessed for the period from January 2012 to June 2020. The study variables included the presence of mandibular third molars, position and angulation. The outcome variables were angle and condylar fractures. Results the mean age was 28.5 years (range 15-89) and 93.2% (n = 499) were male. Angle fractures were significantly more frequent with an impacted wisdom tooth (M3) ( p = 0.023) whereas condylar fractures were more commonly associated with a fully erupted M3. The highest incidence of angle fractures was observed with wisdom teeth classified as class II ( p = 0.026) and position B ( p = 0.05). In contrast, class I wisdom molars were more frequently associated with condylar fractures. With regards to the angulation of wisdom teeth, angles between 80 o – 100 o were highly correlated with angle fractures ( p = 0.020) whereas M3 angulations of 60 o – 80 o were related to condylar injuries (p = 0.025). Conclusions fractures of the mandibular angle were significantly associated with Class II and position B wisdom teeth whereas class I third molars were associated with fracture of the condyles. The likelihood of angle and condylar fractures almost doubled when M3 angulations were (80-100) and (60-80) respectively.

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