Management of third molars projected into the temporal fossa and infratemporal fossa: systematic literature review

Abstract

Introduction: Projection of the maxillary third molar into the temporal or infra temporal fossa is a rare complication. There is no recommendation for the management of such complication. The aim of this work is to try establishing a removal protocol. Materials and methods: A systematic review of the literature was conducted using all cases reports of iatrogenic projection of the tooth into the temporal fossa or infratemporal fossa and how they were treated. The last search was conducted in July 2021. Results: 27 cases involving 28 teeth, published between 1986 and 2020 were included. Discussion: The intraoral approach seems to be preferred in the first instance for teeth in the infra temporal fossa and a cutaneous approach for teeth in the temporal fossa. This should be done within 3–6 weeks after projection to attempt removal. This allows the formation of a fibrous capsule and the downward migration of the tooth to facilitate removal. The use of complementary technological means can improve the chances of success. Conclusion: Resulting a flow chart, who is an aid to management of this type of situation, providing a clear idea of the approach to be taken.

Inverted Maxillary Third Molar Impaction within the Maxillary Sinus: A Rare Case Report

“…Although maxillary impacted tooth displacement into the maxillary sinus or infratemporal fossa is rare [ 21 ], this case displayed a considerable risk of tooth displacement into these spaces due to its position within the sinus. The high position and complex relationship of this impacted third molar with the posterior wall of the maxillary sinus complicates the surgical procedure, and the accessibility to the tooth in such an inverted position is very challenging, with high morbidity [ 22 ]. The procedure comprises a significant number of complications: displacement of the tooth into the sinus, sinus membrane perforation, and bleeding are possibly encountered intraoperatively.…”

“…They surveyed the iatrogenic displacement of the maxillary third molar into the infratemporal fossa or the temporal fossa reported in the literature and reported a total of 27 clinical cases of projected teeth, in which 22 teeth were projected into the infratemporal fossa and 5 teeth were projected into the temporal fossa. They concluded that these complications should be managed carefully, following a structured decision-making process; otherwise, they can lead to further complications [ 22 ].…”