[Surgical treatment of lower jaw pseudoarthrosis as a result of fracture non-treatment following tooth extraction].

Fracture of the lower jaw following tooth extraction is a rare and severe complication, occurring most often in the preangular region following third molar extraction. When left untreated, pseudoarthrosis can occur. Symptoms show a wide variance, including pathologic mobility, pain and infection, as well as sometimes trismus before and following surgical treatment. The possible complications of pseudoarthrosis may be malnutrition, jaw deformity and long-term disability. Treatment options range from prescription of a soft diet in case of simple fracture to surgical treatment by open reduction and internal fixation. A case is presented where a 47-year-old male suffered from painful perimandibular swelling and complained of "instability" of the lower jaw as well as hypoesthesia in the area of the left mental nerve. Case history revealed that he had had extraction of the lower left second molar (tooth 37) four months before. Following clinical and radiographic examination he was diagnosed with non-diagnosed and/or non-treated lower jaw fracture. The patient was surgically treated using an oseosynthetic plate to ensure stability. The postoperative protocol showed satisfactory results. Bone growth in the fracture line was recorded in the follow up. However, due to the four-month period of pseudoarthrosis and infection, the plate was removed much later than it would have been the case if surgical treatment had been performed immediately following the fracture. The delayed diagnosis of this fracture demonstrates the necessity of radiologic control when a fracture is suspected following tooth extraction. When a patient shows symptoms inconsistent with those following tooth extraction, surgical consultation is recommended.