Unique tooth dislocation into submental space during a pan facial trauma - Importance of an orthopantomogram

There are certain reported cases of unusual displacements of teeth involved in a maxillofacial trauma to the maxillary sinus, nasal cavity, gastrointestinal tract or the airway, if worst. All these usually lead to complication the worst being death. So enquiring about them is a very essential part of surveying a maxillofacial trauma patient involving dentition.

This patient was referred to our department for a dental consultation for his ill-defined firm, mildly tender, non-suppurative, submental swelling unresponsive to medication. He had undergone a polytrauma involving his face two months back. An orthopantomogram was ordered which showed a lower central incisor from the fracture site had slipped through the fracture gap into the submental space possibly missed by the CT scan. There was also a lower border splaying at the fracture site. A layer-wise dissection was done extra-orally to retrieve the tooth.

This case envisages the importance of an OPG as an adjuvant to the basic radiographic study, in the emergency room, for a patient with oral and maxillofacial trauma. It also establishes the importance of a meticulous secondary survey, including counting the number of teeth and establishing a correct occlusion to avoid a complication and re-operation. Besides, a medical negligence lawsuit can also arise as some teeth may slip to lungs even.