Foreign Body in the Masticatory Space as a Rare Complication of Orthognathic Surgery and Associated Dental Procedures: A Case Series and Literature Review

Abstract

Background: Foreign bodies (FBs) within the masticatory space are a rare but significant complication of oral and maxillofacial procedures. Despite advancements in orthognathic surgery, instrument breakage and accidental loss can lead to challenging secondary procedures. Clinical experience with retained foreign bodies in the masticatory space following orthognathic surgery and related dental procedures is summarized. Methods: A retrospective search was conducted in the surgical and radiological database of a tertiary referral center for maxillofacial surgery, covering procedures from January 2017 to December 2024. Patients were included if they had undergone orthognathic surgery and presented with a retained FB in the masticatory space confirmed through imaging. Clinical records, operative notes, imaging studies, and follow-up data were reviewed. Results: Out of 2092 procedures, four patients (0.19%) were identified. Two FBs were related to broken surgical instruments during orthognathic surgery (a suture needle and a burr fragment), while two were fractured local anesthesia needles during third molar extraction under local anesthesia. All FBs were located in deep compartments of the masticatory space (paramandibular or pterygopalatine region). Surgical retrieval via transoral approach under general anesthesia was successful in all cases. One patient experienced transient facial nerve dyskinesia; no long-term complications or recurrences were noted. Conclusions: Retained foreign bodies in the masticatory space are infrequent yet warrant prompt recognition and surgical management to mitigate the risk of infection, nerve damage, and repeated procedures. Thorough instrument checks, proper technique, and advanced imaging modalities are crucial for minimizing these complications in orthognathic surgery.

Keywords: computed tomography; foreign bodies; masticatory muscles; orthognathic surgery; postoperative complications; surgical instrumentation.

Figure 1

Axial computed tomography (CT) image demonstrating the presence of a suture needle within the left masticatory space. The foreign body is indicated by a dotted circle.

Figure 2

Coronal, 3D and axial Angio CT preoperative images localizing the foreign body in proximity of the right jugular vein (A–C); foreign body removal with intraoperative C-arm X-ray (D,E). The foreign body is indicated by a dotted circle.

Figure 3

CT Coronal and sagittal scans locating the foreign body in the left pterygopalatine space (A,B); intraoperative removal from transoral approach and using CT-based intraoperative navigation (C,D). The foreign body is indicated by a dotted circle.

Figure 4

CT sagittal images showing syringe needle in the masticatory space (A–C) and surgical removal with intraoperative C-arm X-ray (D). The foreign body is indicated by a dotted circle.

Figure 5

This diagram outlines the process for managing a suspected or confirmed foreign body (FB) in the masticatory space. The 5 steps process includes identifying the FB, assessing its characteristics and risks, and deciding on a treatment approach based on risk assessment.