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Introduction: Surgical techniques for wisdom tooth extraction are very well described and codified in the literature. As far as standard approaches are concerned, oral surgeons enjoy a wide array of therapeutics and methods to remove impacted third molars. However, conventional intra-oral first path is not suitable when it comes to atypical inclusion and/or limited access. Observation: This paper illustrates extreme situations where the intraoral armamentarium shows its weaknesses: first, two cases where modified submandibular access was successfully used to remove deeply impacted lower third molars; and 1 case where Lefort I osteotomy was achieved to remove a maxillary third molar projected into the pterygo-maxillary fossa. Discussion: The extra-oral surgical approach for dental extraction is very rare and in most cases the classical intra-oral approach dominates. However, when intraoral surgery of the pterygo-maxillary fossa is impossible by the conventional endobuccal method, appropriate extra-oral approaches might be useful. Conclusion: Rarely, atypical surgical approaches may be used for removal of ectopic third molars. Introduction : Les techniques d'avulsion de dents de sagesse sont un sujet très bien documenté dans la littérature. Tant que leur position est classique, les chirurgiens ont à disposition un large éventail de thérapeutiques et de méthodes afin d'avulser ces dents. Dès qu'elles ont une position atypique ou un accès chirurgical très limité, il n'y a plus de consensus. Observation : Cet article met en avant des situations où l'abord intra-oral classique trouve ses limites : deux cas cliniques illustrent une voie d'abord sub-mandibulaire modifiée pour l'avulsion de dents de sagesse mandibulaires en position très basse, et un troisième cas clinique décrit une voie d'abord de type Lefort I pour l'avulsion d'une dent de sagesse maxillaire ayant migré dans la fosse ptérygomaxillaire. Discussion : L'approche chirurgicale extra-orale pour une avulsion dentaire est exceptionnelle et dans la plupart des cas, une approche conventionnelle intra-orale suffit. Mais, lorsque une approche chirurgicale intraorale de la fosse ptérygo-maxillaire est impossible, une voie d'abord extra-orale appropriée peut être utile. Conclusion : Rarement, une approche chirurgicale atypique pour les avulsions de dents de sagesse ectopiques peut être utile. [ABSTRACT FROM AUTHOR]

A 23 year-old-woman was referred to point out for pain on the left side of her face and mucopurulent rhinorrhoea lasting for 07 months with long history of recurrent sinusitis. Antibiotics and pain-killers were prescribed to him in the first time. On examination of the oral cavity, all the permanent teeth were present. At nasal endoscopic examination we found a mucopus trickling from the left middle meatus.clinical diagnosis is for sinusitis of dental origin, fungal sinusitis or chronic rhinosinusitis Coronal computed tomography (CT) of the paranasal sinuses revealed the presence of a supernumerary molar tooth (Arrow) within left maxillary sinus floor (A). The tooth was extracted by traditional approach (Caldwell-Luc procedure) from the maxillary sinus under general anesthesia (B, C, D), and the patient has been asymptomatic for more than 02 years. The presence of ectopic or supernumerary tooth in the maxillary sinus is most often asymptomatic but on rare occasions can be a cause of recurrent sinusitis. The supernumerary ectopic tooth is a very rare condition, usually it's localized on the maxillary sinus, and other sites were described like nasal cavity or chin. Coronal computed tomography is sufficient to determine extract localization. The extraction can be made by conventional approach or by transnasal endoscopic approach with less morbidity.