DOI: 10.1055/s-0036-1594275
Ectopic Molar Removal from the Ramus/Condyle Unit: A Minimally Invasive Approach
Publication History
30 June 2016
02 September 2016
Publication Date:
03 January 2017 (eFirst)

Abstract
Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, etiology, indications for removal, and surgical techniques was completed. In addition, a case report is presented of an ectopic mandibular molar in the mid-ramus region which was removed via a minimally invasive, intraoral, technique combining the use of endoscopy and piezoelectric surgery. The authors advocate this technique as it offers the following advantages: avoidance of injury to branches of the facial nerve, unaesthetic scars, and sialocele formation; maximization of surgical field visualization with limited dissection; ability for safe sectioning of the tooth with minimal risks to adjacent structures; and precise bone removal, reducing the risk of iatrogenic or postoperative mandible fracture.
References
- 1 Fındık Y, Baykul T. Ectopic third molar in the mandibular sigmoid notch: report of a case and literature review. J Clin Exp Dent 2015; 7 (01) e133-e137
- 2 Adachi M, Motohashi M, Nakashima M, Ehara Y, Azuma M, Muramatsu Y. Ectopic third molar tooth at the mandibular notch. J Craniofac Surg 2015; 26 (05) e455-e456
- 3 Lee YK, Park SS, Myoung H. Surgical extraction of mandibular third molar in pterygomandibular space: a case report. J Korean Assoc Oral Maxillofac Surg 2013; 39 (05) 242-245
- 4 Bowman J, O'Regan B, Bhopal S. Transmasseteric antero-parotid approach: a technique adaptation for ectopic subcondylar third molar removal and associated dentigerous cyst enucleation. Br J Oral Maxillofac Surg 2014; 52 (01) e7-e8
- 5 Sanghera RK, Jones J. Parotid fistula--an extra-orally draining infected dentigerous cyst associated with a supernumerary fourth molar in ascending ramus. Dent Update 2013; 40 (04) 343-345
- 6 Iglesias-Martin F, Infante-Cossio P, Torres-Carranza E, Prats-Golczer VE, Garcia-Perla-Garcia A. Ectopic third molar in the mandibular condyle: a review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17 (06) e1013-e1017
- 7 Lambade P, Lambade D, Dolas RS, Virani N. Ectopic mandibular third molar leading to osteomyelitis of condyle: a case report with literature review. Oral Maxillofac Surg 2013; 17 (02) 127-130
- 8 Scott N, Bater A, Wilson A. An unusual cause of a facial swelling. J Surg Case Rep 2012; 2012 (10) 10
- 9 Kim JS. Cone beam computed tomography findings of ectopic mandibular third molar in the mandibular condyle: report of a case. Imaging Sci Dent 2011; 41 (03) 135-137
- 10 Procacci P, Albanese M, Sancassani G, Turra M, Morandini B, Bertossi D. Ectopic mandibular third molar: report of two cases by intraoral and extraoral access. Minerva Stomatol 2011; 60 (7–8) 383-390
- 11 Shivashankara C, Manjunatha BS, Tanveer A. Ectopic mandibular third molar in subcondylar region: report of a rare case. Oral Maxillofac Surg 2012; 16 (01) 153-155
- 12 Pace C, Holt D, Payne M. An unusual presentation of an ectopic third molar in the condylar region. Aust Dent J 2010; 55 (03) 325-327
- 13 Bortoluzzi MC, Manfro R. Treatment for ectopic third molar in the subcondylar region planned with cone beam computed tomography: a case report. J Oral Maxillofac Surg 2010; 68 (04) 870-872
- 14 Gadre KS, Waknis P. Intra-oral removal of ectopic third molar in the mandibular condyle. Int J Oral Maxillofac Surg 2010; 39 (03) 294-296
- 15 Sembronio S, Albiero AM, Zerman N, Costa F, Politi M. Endoscopically assisted enucleation and curettage of large mandibular odontogenic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107 (02) 193-196
- 16 Kupferman SB, Schwartz HC. Malposed teeth in the pterygomandibular space: report of 2 cases. J Oral Maxillofac Surg 2008; 66 (01) 167-169
- 17 Salmerón JI, del Amo A, Plasencia J, Pujol R, Vila CN. Ectopic third molar in condylar region. Int J Oral Maxillofac Surg 2008; 37 (04) 398-400
- 18 Wang CC, Kok SH, Hou LT. , et al. Ectopic mandibular third molar in the ramus region: report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105 (02) 155-161
- 19 Wong YK, Liew JC, Tsui SH, Cheng JC. Ectopic molar near the coronoid process: case report. Quintessence Int 2007; 38 (07) 597-600
- 20 Silva GC, Silva EC, Gomez RS. Migration of an unerupted second molar to the condyle: report of a case with sequential radiographs. J Oral Maxillofac Surg 2007; 65 (03) 570-572
- 21 Suarez-Cunqueiro MM, Schoen R, Schramm A, Gellrich NC, Schmelzeisen R. Endoscopic approach to removal of an ectopic mandibular third molar. Br J Oral Maxillofac Surg 2003; 41 (05) 340-342
- 22 Tümer C, Eset AE, Atabek A. Ectopic impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst: a case report. Quintessence Int 2002; 33 (03) 231-233
- 23 Bux P, Lisco V. Ectopic third molar associated with a dentigerous cyst in the subcondylar region: report of case. J Oral Maxillofac Surg 1994; 52 (06) 630-632
- 24 Chongruk C. Asymptomatic ectopic impacted mandibular third molar. Oral Surg Oral Med Oral Pathol 1991; 71 (04) 520
- 25 Yusuf H, Quayle AA. Intracondylar tooth. Int J Oral Maxillofac Surg 1989; 18 (06) 323
- 26 Srivastava RP, Singh G. An unusual impacted inverted molar in mandibular condyle with preauricular sinus (a case report). J Indian Dent Assoc 1982; 54 (02) 67-69
- 27 Burton DJ, Scheffer RB. Serratia infection in a patient with bilateral subcondylar impacted third molars and associated dentigerous cysts: report of case. J Oral Surg 1980; 38 (02) 135-138
- 28 Schwimmer A, Keaveny JT, Caponigro C, Ragaini VE. Subcondylar impaction of a third molar resulting in chronic preauricular sinus: report of case. J Oral Surg 1972; 30 (01) 41-44
- 29 Robiony M, Polini F, Costa F, Sembronio S, Zerman N, Politi M. Endoscopically assisted intraoral vertical ramus osteotomy and piezoelectric surgery in mandibular prognathism. J Oral Maxillofac Surg 2007; 65 (10) 2119-2124