Reem Ahmed, Hasan Siddiqui, Muzzammil A Nusrath
Ectopic mandibular third molars (EMTM) with a heterotopic position in the ramus, condylar and sigmoid notch areas are a rare phenomenon, with an unknown definitive aetiology. The aim of the study is to review the prevalence of EMTM in the literature, alongside the variable clinical presentations and management.
We report a case of a 24-year-old Caucasian female who was referred by her GDP complaining of mild discomfort of the right mandible with no obvious clinical cause. OPG and CBCT assessment identified an ectopically positioned mandibular third molar in the right subcondylar region. Initial conservative management was unsuccessful, and patient remained symptomatic. Traditional surgical approaches including preauricular, endauricular and transcervical/parotid were deemed inappropriate due to the increased risk of paraesthesia, facial nerve weakness, sialoceles, and prolonged recuperation period. An intraoral surgical approach was then adopted using a 30˚endoscope to aid the precise and complete removal of the tooth. Resultantly there was minimal removal of bone which greatly reduced the morbidity associated with the procedure. Review of the literature showed only 24 reported cases of EMTM, with a heterotopic position in the condylar region being the most common. Out of all the surgical managements, we present the first endoscopically aided approach to have been carried out in the UK.
Ectopic mandibular third molars can present with a range of symptoms that make correct diagnosis difficult. The unconventional position of the tooth means that conventional surgical approaches carry increased risk of irreversible damage and fracture. It is important to consider all treatment options in order to provide the patient with the best possible outcome. In our experience, an endoscopically assisted surgical removal of ectopic wisdom teeth has been successful.