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The unilateral sagittal split osteotomy: A useful tool in the armamentarium for deeply impacted mandibular third molars Ross Leader Ashwin Kerai Laura Wade David Houghton Dental Update 2025 51:7, 490-494.
The unilateral sagittal split osteotomy may not be a particularly popularized method to access and remove impacted mandibular third molars (M3Ms). However, in unusual cases of deep impaction, it can provide a surgical option that minimizes bone removal and may reduce the risk of iatrogenic mandibular fracture and inferior alveolar nerve (IAN) injury, depending on the position of the third molar relative to the neurovascular bundle.
CPD/Clinical Relevance:
The unilateral sagittal split osteotomy may present an alternative method for removing impacted mandibular third molar teeth in certain situations.
Article
Mandibular third molar surgery is collectively one of the most common surgical procedures performed in secondary care.1 The unilateral sagittal split osteotomy is perhaps not a very well popularized method to access and remove impacted mandibular third molars (M3Ms). However, in unusual cases of deep impaction, it can provide a surgical option that minimizes bone removal and may reduce the risk of iatrogenic mandibular fracture and inferior alveolar nerve (IAN) injury, depending on the position of the third molar relative to the neurovascular bundle. With this in mind, we present a clinical case managed via this approach, and discuss the evidence base around imaging for impacted mandibular third molars (M3Ms) and the latest guidelines for their extraction.
A 62-year-old male of European origin was referred to the on-call oral and maxillofacial surgery core trainee via accident and emergency (A&E) with a 2-day history of discomfort and swelling to the right submandibular region. He was assessed initially with a provisional diagnosis of right submandibular gland sialadenitis and discharged with a 5-day course of amoxicillin and metronidazole. The patient was booked for follow up on the maxillofacial clinic 2 weeks later. At that review, signs and symptoms had settled and cone beam computed tomography (CBCT) was ordered to determine the position of the inferior alveolar nerve as the lower right third molar was felt to be the primary cause on review of the orthopantogram (OPG) (Figure 1).
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