21/11/2025
Sharing this challenging case as a learning moment for all of us—GP colleagues and surgeons alike.
I took charge of the management of a patient whose 48 fractured during extraction, with the apical fragment migrating into the submandibular space beneath the mylohyoid muscle.
A 3D scan performed a few days later helped us locate the fragment precisely. A full-thickness lingual flap was elevated using a distal–buccal releasing incision and a mesial–lingual discharge between the two premolars. The dissection was carried out very carefully to protect the lingual nerve.
After about 45 minutes of delicate work, the fragment was retrieved safely with no complications.
The lingual nerve can be seen in the short clip, and the apical fragment appears in the last video.
While rare, this complication is always possible—especially with deeply lingual mandibular third molars.
A gentle reminder that these cases require special attention and a cautious approach. Retrieval attempts carry significant risks—lingual nerve injury, vascular damage in the sublingual or submandibular spaces, and trauma to adjacent glands.
We keep learning with every case, and sharing helps our whole community progress.