SERIOUS COMPLICATIONS FROM WISDOM TEETH: MANDIBULAR OSTEOMYELITIS – MASSETERIC ABSCESS CAUSED BY IMPACTED, MISALIGNED TOOTH 38

Wisdom teeth—often thought to be a normal part of oral anatomy—can actually pose serious risks if they are misaligned, impacted, or not properly monitored and treated in time. The case of a 29-year-old female patient below is a typical example of severe complications caused by a wisdom tooth.

1. Case Overview

The patient was admitted with swelling and pain in the left cheek, inability to open her mouth, and severe swelling in the left cheek area, causing significant pain and affecting eating and daily activities.

Through examination and diagnosis, the doctor had to perform emergency surgery: removal of inflamed bone, debridement of necrotic bone, excision of necrotic muscle tissue, and extraction of the problematic wisdom tooth. After treatment, the patient’s condition stabilized, but this case serves as a strong warning about the dangers of complications from wisdom teeth.

 2. Initial Condition

The 29-year-old female patient was admitted with swelling and pain in the left cheek and restricted mouth opening. According to her history, in March 2025, she experienced similar swelling and pain and was diagnosed with a masseteric abscess, which was treated with antibiotics at a medical facility.

About 10 days before hospital admission, the swelling in the left cheek recurred and progressed rapidly: increased swelling and pain, no fever but significantly reduced ability to open the mouth. Recognizing abnormal signs, the patient decided to seek hospital care for specialized treatment.

3. Diagnosis & Treatment Indication

The attending physician conducted a clinical examination combined with necessary tests such as soft tissue ultrasound and facial CT scan. The results showed:

• A 5x5 cm swelling mass in the left cheek and jaw angle area, firm and hard on palpation.
• Intraoral: limited mouth opening, tooth 38 not visible on the dental arch, no signs of pus.
• X-ray and CT imaging: impacted and misaligned tooth 38, extensive lesion spreading to the left masseteric space, with bone loss at the mandibular angle and body.

Based on the examination results and imaging, the doctor diagnosed: Left mandibular osteomyelitis – Diffuse abscess in the left buccal – masseter region due to wisdom tooth No. 38.

After the examination, the doctor indicated surgery: removal of inflamed bone, debridement of necrotic bone, removal of necrotic muscle tissue, and extraction of the causative wisdom tooth.

4. Surgical procedure

The patient was indicated for emergency surgery and the following steps were carried out:

• Incision and drainage of abscess, cleaning of the lesion
• Removal of inflamed bone and periosteum, debridement of necrotic bone
• Resection of inflamed masseter muscle
• Extraction of teeth No. 28 and 38
• Drain placement

5. Outcome

Postoperatively, the patient’s condition was stable and continued to be monitored and treated according to the postoperative protocol.