Case Spotlight: Persistent Pain Following Maxillary Third Molar Extraction

A patient presented with persistent pain following extraction of the maxillary right third molar (#1).

CBCT demonstrated:

A continuous osseous defect extending from the distal aspect of #2 into the extraction site
Complete loss of the buccal cortical plate
Disruption of the posterolateral wall and floor of the right maxillary sinus
Associated mucosal thickening of the right maxillary sinus

The imaging findings raised concern for possible injury involving the posterior superior alveolar (PSA) neurovascular bundle. This neurovascular bundle supplies the posterior maxilla and enters the maxilla through the posterior superior alveolar foramina located on the posterior surface of the maxillary tuberosity.

posterior superior alveolar neurovascular bundle cbct

Although nerve injuries are more commonly discussed in the mandible, this case is a reminder that the posterior maxilla also contains important neurovascular structures that may be affected during surgical procedures.

posterior superior alveolar artery anatomy

Understanding the regional anatomy and correlating imaging findings with the patient’s symptoms is essential when evaluating persistent postoperative pain.

Cases like this reinforce that CBCT is valuable not only for treatment planning, but also for investigating unexpected postoperative complications.