A 38-year-old male was referred to Maxillofacial Surgery Department by an Orthodontist with pain and swelling on the left side of the jaw along with the difficulty of opening the mouth. Pain was sharp, intermittent and radiating to the temple and to the back of the neck. He gave a history of similar episode previously twice and resolved with the antibiotic therapy. On examination swelling was present on the left side near the angle, which was diffused and extending to the neck region. The mouth opening was reduced to 22mm. The OPG [Table/ Fig-1] showed obliquely and deeply impacted left third molar (Class 3, Position C) immediately related to the inferior dental nerve and above the angle of the mandible. There was increase in the size of the follicular space associated with the crown of the tooth. Lateral oblique view [Table/ Fig-2] shows the mesioangularly impacted third molar which is Class III, positioned 1.5cm distal to the roots of the second molar and close to the left angle with bulky roots. All other teeth on left quadrant were healthy and case was diagnosed to be odontogenic infection from the mesioangular Class III, Position C impacted left lower third molar.As the patient was continuing with the symptoms, the decision was to remove the impacted ectopically placed mandibular left lower third molar tooth under general anaesthesia with antibiotic cover (Cefotaxim 1gm BD and inj Metronidazole 500mg TID through intravenous route for seven days). As the position was not favourable for trans-oral procedure, extra-oral approach was planned. Patient was taken for extra oral approach after explaining the benefits of procedure which will prevent the damage to the inferior alveolar nerve, possibility of mandibular angle fracture and difficulties arise due to the limited accessibility and visibility to perform the procedure intra orally. The written informed consent was taken prior to general anaesthesia. A standard submandibular approach was used with Risdon incision [Table/ Fig-3]. Platysma divided the marginal mandibular nerve branch of facial nerve identified and retracted. After dividing the masseter muscle, through the sub periosteal reflection the lateral surface of the ramus aBstRaCt Extra oral approach for removal of the lower third molar is uncommon. This case report illustrates an example of removal of lower third molar by extra-oral approach preserving the inferior dental nerve was exposed. The site of impacted tooth presented as smooth elevation, guttering was done using the bur taking the advantage of follicular space crown was exposed. The neurovascular bundle was placed just above the crown of the impacted tooth [Table/ Fig-4] carefully dissected out of the canal. The buccal surface of the crown exposed used as a guide for entire tooth removal. The follicle was removed and thoroughly copious irrigation done after smoothing the sharp margins with bur and bone file. Inferior dental nerve replaced in the bed again [Table/ Fig-5] and soft tissue closure done in layers. Postoperative recovery was good, ...