Fracture of the maxillary tuberosity: Troubleshooting in general dental practice and a proposed fracture classification

Tooth extraction can introduce a wide range of complications and risks. A complication of maxillary extractions is the fracture of the tuberosity with incidence documented at approximately 0.15–0.6%.^1,2 Despite not being well documented in the literature, this type of complication can have a significant morbidity for patients³ and, in a few case reports, has been life threatening.^{4, 5}Figure 1 shows a patient who experienced a tuberosity fracture during third molar removal and developed a lateral pharyngeal haematoma, presenting with severe facial swelling and dysphagia. The patient required urgent admission and emergency treatment to evacuate the haematoma and achieve haemostasis.

To assist with the diagnosis and management of a fracture, a classification system would be beneficial. To date such a system does not appear to be available. The aim of this article is to provide a troubleshooting guide for diagnosing and managing tuberosity fractures and propose a system of classification to facilitate discussion, consent process, management and referral of these fractures.