Mandibular Condyle Osteomyelitis Following Third Molar Extraction: A Case Report and Literature Review

Osteomyelitis of the mandibular condyle is an exceptionally rare but clinically significant infection, usually due to odontogenic sources. We report a case of a 33-year-old healthy male patient who developed condylar osteomyelitis after the extraction of an impacted lower right third molar (tooth 48). Seven days after the extraction, the patient reported increasing pain and trismus, and an initial trial of a muscle relaxant provided no clinical benefit. Maxillofacial CT scan revealed a 6 cm abscess along the medial aspect of the right mandibular ramus. Dual oral antibiotics (amoxicillin/clavulanate and metronidazole) were started, but a control CT scan showed an unchanged collection, prompting incision and drainage with pus sampling. Microbiology isolated Parvimonas micra and Prevotella nigrescens (susceptible to amoxicillin/clavulanate, metronidazole, and meropenem; resistant to clindamycin). The patient received 12 days of intravenous antibiotics and physiotherapy, with marked clinical improvement. After discharge, he continued long-course oral antibiotics for four weeks. At the six-month follow-up, the patient was asymptomatic, with full pain-free temporomandibular joint (TMJ) mobility and mouth opening >45 mm. The final CT scan demonstrated restitution of normal cortical continuity and marked reduction of previous bone rarefaction, consistent with spontaneous bone regeneration of the mandibular condyle. To deepen our understanding, we conducted a PubMed literature review (2000-2024; English; condylar involvement; abstracts available), which yielded 54 records and 20 relevant articles. Odontogenic infection was the most frequent etiology, followed by tuberculous and otologic/medication-related osteonecrosis of the jaw (MRONJ)‑related causes. CT typically reveals an osteolytic, eroded condyle; management combines drainage/debridement and prolonged antibiotics (6-8 weeks), reserving condylectomy for refractory or necrotic cases. This case underlines the value of early imaging and culture‑guided therapy to preserve TMJ function and avoid ankylosis or deformity.