Page 74 - FINAL COMPENDIUM 2020-2021 27.2.2022

A RARE COMPLICATION FOLLOWING SURGICAL REMOVAL OF LOWER THIRD MOLAR
NMRR ID: 24373

Muhamad Othman FR, Nagaretnam N, Misnon NF, Apipi M

Introduction: Osteomyelitis following surgical removal of lower third molar in a healthy
patient is unusual. Case report: We share a case of osteomyelitis of mandible following a
lower third molar surgery. A 24-year-old gentleman with no comorbidity, and no known
allergies, presented with first episode of right facial swelling with limited mouth opening
for past 2 weeks. Clinically, the swelling was noted extra and intra-orally and was localized
to mesio-angular impacted 48 region. Surgical removal of 48 was performed under local
anaesthesia in an aseptic technique. Post operatively, persistent swelling was present
with no systemic manifestations. An ultrasound taken suggested a right masseter muscle
mass query of Rhabdomyosarcoma. Hence, the patient was sent for magnetic resonance
imaging (MRI). The MRI revealed cortical irregularities and thickened periosteal reactions
of right ramus region which suggests of osteomyelitis. Findings from the biopsy and
wound debridement affirmed the diagnosis of osteomyelitis. Long term antibiotics regime
was administered with good patient compliance. By virtue of cone beam computed
tomography (CBCT), we would be able to narrow down the pool of differentials.
Additionally, periodical CBCT aided well in our follow up to monitor the patient’s recovery.
Conclusion: In conclusion, the importance of CBCT cannot be challenged. It significantly
aids surgeons in deriving a diagnosis.

Keywords: lower third molar surgery, osteomyelitis, CBCT

Virtual oral presentation at the 25 Annual MAOAMS Scientific Meeting on 19 – 20 March 2021
th
Dr Fahrul Radzi bin Muhamad Othman
Dr Nadiah Fatin binti Misnon
Dr Muzaffar bin Apipi
Oral and Maxillofacial Surgery Department
Hospital Slim River
Slim River
Perak

Dr Navina Nagaretnam
Majlis Pergigian Malaysia
Cyberjaya
Sepang
Selangor

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