A wisdom tooth was found in the infratemporal fossa, a deep space behind the cheekbone. [EurAsian Journal of Oral and Maxillofacial Surgery]
A wisdom tooth was found in the infratemporal fossa, a deep space behind the cheekbone. [EurAsian Journal of Oral and Maxillofacial Surgery]

A wisdom tooth that went missing during an extraction more than a decade ago was found lodged deep behind a 35-year-old woman's cheekbone — the unexpected source of jaw pain she had suffered for years without explanation.

After the extraction, the woman had difficulty opening her mouth wide and noticed a foul-smelling discharge inside her mouth. She sought treatment for what she believed was a temporomandibular joint disorder, but her symptoms showed little improvement.

The cause finally came to light during imaging of the interior of her face. A wisdom tooth was found in the infratemporal fossa, a deep space situated behind the cheekbone.

The upper wisdom tooth had apparently never been fully removed during the original procedure. It is believed to have been pushed backward during the extraction, slipping out of the socket and into the infratemporal fossa.

The infratemporal fossa is a deep cavity located on the inner and lower side of the cheekbone. Because blood vessels and nerves pass through the area, a tooth that migrates there poses a risk of damaging surrounding tissue if removal is attempted carelessly.

Upper wisdom teeth in particular can, due to their anatomical position, give rise to a rare complication in which the tooth is displaced into adjacent spaces during extraction. Fewer than 50 such cases have been reported in the medical literature.

Surgeons used three-dimensional imaging to pinpoint the exact location of the tooth before proceeding with removal.

Rather than making an incision on the outside of the face or jaw, the surgical team approached through the inside of the mouth under local anesthesia. After retrieving the tooth from the infratemporal fossa, they covered the site with fatty tissue from the inner cheek.

The patient experienced no significant complications after the surgery, and the symptoms that had troubled her for years — including pain and restricted mouth opening — resolved.

The case was reported by researchers in Turkey and published Sunday in the EurAsian Journal of Oral and Maxillofacial Surgery.


bbo@heraldcorp.com