Primum Non Nocere: A Case Report of Iatrogenic Fracture of the Mandibular Angle During Excision of an Impacted Third Molar

Abstract

Third molar extractions are one of the most commonly performed dental procedures. It is associated with numerous complications, of which mandibular angle fracture is a rare but distressing complication. These can occur as intraoperative and postoperative (late) events. Iatrogenic fractures involving the angle of the mandible represent a unique challenge for management owing to their complex biomechanics and various anatomical factors. Intraoperative fractures occur due to various reasons, which include the position of the tooth, depth of impaction, extent of odontectomy performed, and injudicious use of dental elevators. This exhibited report describes a case of iatrogenic mandibular angle fracture (IFM) during excision of an impacted third molar in a 30-year-old female. Additionally, it discusses the various reasons and preventive strategies to avoid such complications.

Keywords: iatrogenic fracture; mandibular angle fracture; primum non nocere; third molar complications; third molar extraction.

Figure 1. Orthopantomogram showing oblique radiolucent line extending from the extraction socket of the right third molar fracturing the right angle of the mandible (arrow).

Figure 2. Coronal cut showing right mandibular angle fracture (arrow).

Figure 3. Plating of the superior border via the transoral approach.

Figure 4. Postoperative orthopantomogram showing fixation of the superior border and lateral border with miniplates and screws (arrow).