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Don’t fail to diagnose

15 July 2014
Complications which arise during any treatment need to be diagnosed, recorded and sorted, such as described in this case...

A fit and well patient attended a general anaesthetic outpatient operation to remove all four third molars. The records were very brief and did not mention any particular complications. The pre-operative radiograph showed that both mandibular third molars were difficult disto-angular impactions.

At the review appointment one week later, the patient stated that she had experienced difficulty opening her mouth and that the lower lip on the right was still numb. She was discharged with the explanation that this was a normal consequence of the surgery and was advised to return if she was concerned.

A crunching sound

The patient complained that every time she ‘bit together’ she heard a crunching sound! A second dentist working at the same practice reviewed the patient on two occasions. At a third appointment several months after the original surgery, this same dentist took a new radiograph which revealed that the mandible had been fractured and it was not healing satisfactorily.

The patient was referred to her local maxillofacial unit and had the fracture site explored and plated in the correct occlusal relationship under general anaesthetic. A fibrous non-union was discovered. The patient went on to make a satisfactory recovery apart from loss of sensation in the mental nerve.

Learning Point:
While a fractured mandible is unusual following the removal of a tooth, it does not automatically warrant criticism, although failure to diagnose such a fracture well might.
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