title: Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature.
abstract: OBJECTIVE
  The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used.
  
  
  METHODS
  A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps.
  
  
  CONCLUSIONS
  Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.
authors.affiliation: Center for Dental Medicine Sciences, Department of Oral and Maxillary Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Sencimen
authors.affiliation: Kars Center for Oral and Dental Health, Kars, Turkey. aydingulses@gmail.com.
authors.forename: Aydin
authors.initials: A
authors.lastname: Gülses
authors.affiliation: Center for Dental Medicine Sciences, Department of Oral and Maxillary Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Sencer
authors.initials: S
authors.lastname: Secer
authors.affiliation: Center for Dental Medicine Sciences, Department of Oral and Maxillary Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Zerener
authors.affiliation: Center for Dental Medicine Sciences, Department of Oral Radiology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Savaş
authors.initials: S
authors.lastname: Özarslantürk
mesh_terms: D006801:Humans; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000601:surgery*; D009957:Oroantral Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D011862:Radiography, Panoramic; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Displacement; Infratemporal fossa; Maxillary third molar