2017 Volume 63 Issue 7 Pages 369-373
We report two cases of a mandibular third molar enclosing the inferior alveolar neurovascular bundle between the tooth roots with apical adhesion.
A 60-year-old woman (case 1) and a 79-year-old woman (case 2) underwent third molar extraction because of right mandibular osteomyelitis and left mandibular pericoronitis, respectively. In both patients, only the occlusal surfaces of the third molars were visible on intraoral examination. Their mandibular canals and third molar roots crossed on panoramic radiography. The white line of the mandibular canal wall was unclear only in case 1, suggesting that a neurovascular bundle passed between the roots of the tooth. We recognized this anomaly on preoperative computed tomography (CT), and the neurovascular bundle was preserved by careful root separation during the extraction. In case 2, the same operative technique was used for the extraction, without performing preoperative CT. Post-extraction paresthesia in both cases was improved by vitamin B12 treatment.
It is difficult to judge such radicular malformation and the position of the neurovascular bundle on the basis of preoperative panoramic radiography alone. Therefore, more detailed investigations by CT are recommended. We highlight the importance of adequate preoperative evaluations to preserve the neurovascular bundle by carefully identifying root separation requirements during third molar extraction.
