Extraoral tooth 48 extraction – a sequence of medical errors and complications

Introduction
Extraction of unerupted wisdom teeth may be associated with a number of potential complications such as postoperative bleeding, infection, dry socket, neurological disorders, intraoperative fracture of the mandible, osteitis, temporary or permanent numbness (paresthesia), abscesses, and hematomas. The literature also contains reports concerning late fractures of the mandible that are complicated with osteitis and required repair with autogenic transplantation. In most cases, the classical intra-oral approach for dental extraction domi- nates because the extraoral approach is connected with more potential complications, specifically nerve and vascular damage, joint injuries and skin scarring, as a result of surgery.

Case report
This paper presents a case of irregularities and complications that occurred during and after the treatment of a female patient who required extraction of tooth 48 (the right lower third molar). First, a procedure other than the treatment that had been planned was performed (removal of a cyst from the right maxillary sinus); then, the second procedure (extraction of tooth 48) was performed without the patient’s consent and with inappropriate extraoral access. Ultimately, the complication that occurred during the treatment, i.e., a fracture of the mandible, was not recognized. The patient was treated for months by various physicians, and eventually, after 8 months, an inveterate fracture of the mandible, requiring reconstructive treatment, was diagnosed. The patient reported the case to the Public Prosecutor’s Office, which ordered an opinion to determine whether the implemented medical procedure was correct.

Conclusions
The described case shows that sometimes the course of treatment can lead to a seemingly incredible accumulation of irregularities and complications. The forensic medical opinion allowed the indictment of the doctor responsible for the irregularities. As a result of the mediation proceedings, the parties managed to avoid a long and costly process and the patient received compensation and reparation.