Abstract
We experienced a case in which a carbide bur fractured during extraction of a third molar, migrated into the soft tissue on the mandibular lingual side, and was complicated by emphysema. A 35-year-old woman underwent dental extraction under local anesthesia at her referring dental clinic based on a diagnosis of horizontally impacted right mandibular third molar. A carbide bur fractured during crown sectioning and was replaced with a new carbide bur to continue the tooth extraction. Although removal of the fractured carbide bur was attempted thereafter, it had migrated to the soft tissue on the lingual side, making its removal challenging. Therefore, the patient was referred to our department 3 days later. Intraoral examination revealed an extraction socket in the area of the right third molar. Redness of the surrounding mucosa, mild swelling, and tenderness were noted, but there were no signs of infection. Panoramic radiography revealed an opaque structure in the right mandible that appeared to be the broken piece of the carbide bur （9mm×1mm）. Plain computed tomography （CT） showed a radiopaque structure in the soft tissue on the right lingual side. Additionally, gaseous images were observed in the upper right temporal space and upper mediastinum. As a treatment policy, it was decided to first prevent infection, confirm the disappearance of emphysema, and then remove the foreign body. The patient was given SBT/ABPC, 3g/day. On day 6, resolution of emphysema was confirmed based on the disappearance of crepitus and CT assessment. The patient underwent foreign body removal under general anesthesia 58 days after the initial diagnosis.
We experienced a case in which a carbide bur fractured during extraction of a third molar, migrated into the soft tissue on the mandibular lingual side, and was complicated by emphysema.
