An extraction complicated by lateral and medial pterygoid tethering of a fractured maxillary tuberosity

We report a case in which the extraction of an upper second molar was complicated by a maxillary tuberosity fracture. Delivery of the tooth and bone fragment under local anaesthesia was unable to be achieved because of pain, brisk bleeding and tethering by the lateral and medial pterygoid muscles. The eventual removal of the fragment under general anaesthetic required the control of haemorrhage deep within the infratemporal fossa. When this complication is recognised by the general dentist the maxillary tuberosity should not be removed and the patient referred to a specialist unit.