Background –

The ectopic placement of the mandibular third molar in the mandibular subcondylar region is uncommon, often complicated by infection and difficult surgical access. This presentation describes a case report and provides systematic review of the literature.

Materials and Methods –

Literature review was performed via electronic search of Medline and Pubmed databases using search criteria – “third molar”, “wisdom tooth”, “ectopic”, “subcondylar” and “infection”. Data was collected as per the following parameters – age, gender, side, location, tooth orientation, associated pathology, chronicity, treatment, complications and outcome.

We also present a case report of a patient treated at the Oral and Maxillofacial Surgery Department, Royal Adelaide Hospital.

Results -

26 relevant articles were identified describing ectopic impactions of mandibular third molars in the subcondylar region, documenting 28 cases over a 35 year period.

A 47 year old male case subject presented with acute exacerbation of a chronically infected lower left third molar tooth (38) ectopically placed in the subcondylar region of the mandible. This was associated with odontogenic infection of the submasseteric space, trismus, and intraoral draining sinus. Surgical tooth removal was performed via an intraoral buccal approach with endoscopic assistance. The patient recovered without complication or pathological mandibular fracture.

Discussion –

Ectopically placed mandibular third molars in the subcondylar region are uncommon, usually presenting with a similar anatomical orientation and clinical picture. Endoscopically-assisted surgical removal of teeth in this region reduces the surgical morbidity in contrast to open extra-oral surgical technique as reported by other authors. This case illustrates the multifocal challenge of managing acute odontogenic infection in the setting of airway compromise, pathological fracture risk, and proximity to vital anatomical structures.

Conclusion –

This case demonstrates the clinical utility of intraoral endoscopic surgical technique in the management of subcondylar ectopic third molar impaction.