PMC9527841_01
Orthopantomogram radiograph showing the ectopic position of the LL8, close to the left angle of the mandible, at the level of the lower border
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He was initially investigated with an orthopantomogram [Figure 1] which showed an ectopic left mandibular third molar.
Computerised tomography scan showing the lingual position of left lower third molar (LL8)
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A computerised tomography scan was taken to further assess the position of the tooth and the associated pathology, and to aid surgical planning [Figure 2].
A dimensional model generated from the computerised tomography scan showing the relationship of the wisdom tooth with the lingual plate
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This showed that the left lower third molar (LL8) was positioned at the lower border of the mandible, on the lingual aspect [Figure 3].
Intraoperative photograph showing the lingual approach
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A subperiosteal flap was raised on the lingual aspect, down to the lower border of the mandible [Figure 4].
Endoscope used during the procedure, the attached guard allowed for retraction of the soft tissues
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An endoscope with a 30  condylar attachment as shown in Figure 5 (Karl Storz, Germany) was used to allow direct visualisation down to the lower border. The guard on the endoscope provided retraction of the soft tissues [Figure 5].
Endoscope image showing the ectopic left lower third molar (LL8)
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The endoscope enabled the surgeon to see the surgical site clearly [Figure 6], allowing for minimal bone removal over the tooth, performed using a bone chisel.
The extracted left lower third molar (LL8)
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Once an adequate portion of the tooth was uncovered, a curved Warwick-James instrument was used to elevate the tooth [Figure 7].