This study proposes a novel intraoral approach combined with sub-sigmoid osteotomy to effectively and safely remove of ectopic third molar teeth without complications.

The procedure included a sub-sigmoid osteotomy to expose and remove the ectopic tooth, followed by fixation of the osteotomized coronoid with titanium plates. Preoperative cone beam computed tomography (CBCT) was used for precise tooth localization.

The ectopic third molar was successfully removed with minimal bone removal. One intraoperative complication, a bad split of the anterior ramus, was observed but managed effectively. Postoperative healing was uneventful, with no nerve injury, infection, or reduced mouth opening.

The transoral sub-sigmoid osteotomy technique is a reproducible, effective method for ectopic third molar removal, avoiding extraoral scars, nerve damage, and extensive dissection. Preoperative planning using CBCT is essential to prevent complications, making this technique a valuable alternative to traditional approaches.