Management of bur fracture in oromaxillofacial surgery: a case series and diagnostic considerations for retrieval versus retention

Abstract

Background: Bur fracture during oral and maxillofacial surgery, although rare (0.2%–2%), presents significant clinical challenges due to potential complications such as tissue migration, infection, and damage to vital structures. Accurate localization and management of fractured burs are essential to optimize patient outcomes, with advanced imaging modalities like cone-beam computed tomography (CBCT) playing a key role in diagnosis and treatment planning. Aim: This case series evaluates diagnostic strategies and treatment decisions in managing bur fractures during oral and maxillofacial procedures, emphasizing the importance of imaging, clinical judgment, and tailored surgical approaches to reduce complications. Materials and Methods: Three cases involving bur fractures during different surgical procedures were reviewed retrospectively. Intraoperative radiographs, CBCT scans, and postoperative imaging were used to locate the fragments. Management strategies ranged from immediate surgical removal to conservative observation based on the fragment’s position, stability, and proximity to vital structures. Clinical follow-up assessed healing and potential complications. Results: In the first case, intraoperative orthopantomography helped successfully remove a bur fragment embedded near the mandibular molar. The second case used postoperative CT imaging to locate a deep fragment in the canine pillar, which was left in place due to its stable position, with subsequent removal during a planned second surgery. The third case involved a deeply embedded fragment in the maxilla, managed conservatively after CBCT confirmed its safe, stable location. All patients remained asymptomatic during follow-up, with no signs of infection or migration. Conclusion: Management of bur fractures should be tailored to the individual, relying on precise imaging, preferably CBCT, to determine the fragment’s position and risk level. Conservative management is appropriate when fragments are stable and away from critical structures, while surgical removal is necessary when easily accessible. Preventive measures, meticulous surgical techniques, and thorough documentation are vital to minimize risks and provide optimal patient care.