Endoscope assisted removal of impacted third molars from the lower mandibular border via lingual access

Purpose

Endoscopes are increasing the surgical spectrum for Oral and Maxillofacial Surgery. Naaj et al. quote that for third molars below the inferior dentoalveolar nerve (IDN), extra-oral removal is the best technique. The authors demonstrate that with endoscopic assistance, deeply impacted third molars can be removed intra-orally instead, without any complications. Endoscopes have demonstrated their usefulness in Oral and Maxillofacial surgery by aiding intra-oral repair of condylar fractures and submandibular gland removal; surgeries that are traditionally carried out with extra-oral access. The authors demonstrate how endoscopes have a place in minor oral surgery, particularly reducing the amount of bone removal needed to gain access to the surgical site.

Methods

The article reports on two case studies of lingually placed third molars lying below the IDN. They were removed with endoscope assisted lingual access. Surgical planning was done using CT/CBCT scanning. The authors also detail how neurosensory disturbance was avoided when raising a lingual flap.

Results

Wisdom teeth were successfully removed in all instances, whole, via lingual access. Patients had uneventful recovery and there were no cases of reported neurosensory disturbance.

Conclusion

The authors demonstrate that the use of an endoscope, CT/CBCT guided surgical planning and careful lingual retraction provides a safe alternative to extra-oral removal of deeply impacted third molars. The advantages are avoidance of post-operative scarring and the potential to operate in ambulatory care.