Mandibular fractures are a rare complication after third molar removal. Symptoms show a wide variance. Treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. This article describes a patient who presented a late mandibular fracture following third molar removal. The fracture was not detectable in radiographs at the time of fracture. Six weeks after the reported cracking noise, the patient presented a mandibular fracture with associated osteomyelitis. Treatment by open reduction and internal fixation and autologous iliac crest graft was performed via a submandibular approach. The delayed diagnosis of this pathologic fracture demonstrates the necessity of repeated radiologic controls to prevent osteomyelitis when a fracture is suspected. (Quintessence Int 2007;38:63–65)

Key words: complication, osteomyelitis, pathologic mandibular fracture, third molar