Maxillary tuberosity fracture during extraction — ORE Part 1 MCQ
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Correct answer: E — Stabilise the segment, halt extraction, and refer for specialist surgical management
Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as D · D = shown as E
When a large mobile maxillary tuberosity fracture is recognised during extraction—especially with a pneumatized sinus—the principle is to halt the procedure immediately and refer for specialist management. Continuing extraction (A) risks catastrophic haemorrhage from the pterygoid plexus and iatrogenic oroantral communication. Removing the segment chairside (B) replicates the error; UK case law (Shah & Bridgman, Br Dent J 2005) explicitly warns that such fragments, particularly those tethered by pterygoid muscles, require general anaesthesia and specialist control of deep-field bleeding. Packing and ignoring (C) or discharge with antibiotics alone (E) leave a mobile, potentially infected bone fragment that will cause chronic sinusitis or fistula formation. The correct approach is stabilisation to prevent further soft-tissue trauma and specialist referral for safe removal under appropriate conditions (D)—the principle endorsed by UK oral surgery practice.
Reference: Shah N, Bridgman JB. An extraction complicated by lateral and medial pterygoid tethering of a fractured maxillary tuberosity. Br Dent J 2005 May 14;198(9):543-4. https://pubmed.ncbi.nlm.nih.gov/15895046/