Iatrogenic Resorption of a Mandibular Condyle Following 3rd Molar Wisdom Tooth Surgery

Unilateral osteoarthritis of the mandibular condyle is typically associated with trauma to the temporomandibular joint from sports activities, falls and criminal assaults. In this unusual case the complete destruction of the condyle occurred after a long difficult extraction of a 3rd molar wisdom tooth in a young adult. Downward and lateral pressure from a dental forceps extraction that was applied anterior to the angle of the mandible, combined with the masseter muscle acting as the fulcrum resulted in rapid and complete resorption of the condyle. Clinical signs showed a marked deviation of the maxillary-mandibular incisal midline and formation of an open bite malocclusion on the unaffected side. There was a restricted oral opening, difficulty in chewing food and the patient was psychologically depressed. Acute pain management was achieved with a soft diet, heat applications and non-steroidal antiinflammatory drugs. Long term pain management strategies included an explanation of current surgical techniques of temporalis muscle flap advancement and joint prosthesis, and the future potential of the ‘stem cell in bioscaffold’ approach for joint regeneration in this young patient.