Ectopic third molar in the mandibular condyle: A review of the literature

Abstract

Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery. Key words:Third molar, ectopic tooth, condyle, mandible.

Dentigerous Cyst Associated with an Ectopic Tooth in the Subcondylar Area: A Case Report and Literature Review

“…Ectopic teeth are those that are impacted in unusual positions or that have been displaced and are at a distance from their normal anatomic location (Iglesias-Martin et al, 2012;Lambade et al, 2013) and have been reported in the mandibular condyle, coronoid process, orbit, palate, nasal cavity, floor of mouth, and maxillary sinüs (Buyukkurt et al, 2010;Pace et al, 2010;Shivashankara et al, 2012;Lambade et al, 2013). The etiology of an ectopic tooth has not yet been completely clarified.…”

“…The etiology of an ectopic tooth has not yet been completely clarified. However, an ectopic eruption may result due to either developmental disturbances, iatrogenic activity, or pathological process such as dentigerous cysts (Pace et al, 2010;Buyukkurt et al, 2010;Shivashankara et al, 2012;Iglesias-Martin et al, 2012). Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, accounting for approximately 24 % of all true cysts of the jaw and are the most common developmental cyst of the jaw (Kocer et al, 2002;McCrea, 2009).…”

“…These lesions progress slowly and are usually painless, but may cause facial swelling and delayed tooth eruption (Kocer et al, 2002;Ustuner et al, 2003;Buyukkurt et al, 2010). Among the 14 case reports summarized in Table I, the most common signs and symptoms associated with ectopic teeth are facial pain (Medici et al, 2001;Tumer et al,2002;Suarez-Cunqueiro et al, 2003;Wang et al, 2008;Salmeron et al, 2008;Gadre and Waknis, 2010;Iglesias-Martin et al, 2012), facial swelling on the preauricular region or ipsilateral side of the mandible (Tumer et al,2002;SuarezCunqueiro et al, 2003;Salmeron et al, 2008;Pace et al, 2010;Gadre and Waknis, 2010;Scott et al, 2012;Iglesias-Martin et al, 2012;Bowman et al,2014) and trismus (Wassouf et al, 2003;Salmeron et al, 2008;Iglesias-Martin et al, 2012), difficulty in mastication (Bux and Lisco, 1994;Medici et al, 2001). In 3 of the 14 summarized patients, intraoral or extraoral drainage of purulent material have been reported (Salmeron et al, 2008;Pace et al, 2010;Gadre and Waknis, 2010).…”

“…In the treatment of ectopic third molars in the condylar region, several approaches have been used, including an intra-oral approach (Medici et al, 2001;Wassouf et al, 2003;Wang et al, 2008;Gadre and Waknis, 2010;Scott et al, 2012;) an endoscopic intraoral approach (Suarez-Cunqueiro et al, 2003) and an extra-oral approach (Bux and Lisco, 1994;Tumer et al,2002;Salmeron et al, 2008;Pace et al, 2010;Iglesias-Martin et al, 2012;Bowman et al,2014). Among the 14 cases summarized in Table I, 7 (Bux and Lisco, 1994;Tumer et al, 2002;Salmeron et al, 2008;Pace et al, 2010;Iglesias-Martin et al, 2012;Bowman et al, 2014) were by an extraoral approach and 7 (Medici et al, 2001;Wassouf et al, 2003;Wang et al, 2008;Gadre and Waknis, 2010;Scott et al, 2012;) were by an intraoral approach.…”

“…Among the 14 cases summarized in Table I, 7 (Bux and Lisco, 1994;Tumer et al, 2002;Salmeron et al, 2008;Pace et al, 2010;Iglesias-Martin et al, 2012;Bowman et al, 2014) were by an extraoral approach and 7 (Medici et al, 2001;Wassouf et al, 2003;Wang et al, 2008;Gadre and Waknis, 2010;Scott et al, 2012;) were by an intraoral approach. The most commonly used extra-oral approaches are retromandibular (Bux and Lisco, 1994;Pace et al, 2010;Iglesias-Martin et al, 2012) and preauricular (Tumer et al,2002;Salmeron et al, 2008). These external approaches have the advantage of good surgical exposure, especially to the body and ascending ramus, to the condylar region, but may result in complications such as cutaneous scar formation, damage of temporomandibular joint components, facial nerve injury in the case of pre-auricular access, or damage of the marginal mandibular branch of the seventh cranial nerve (Medici et al, 2001;Wang et al, 2008;Sanghera and Jones, 2013).…”