Abstract: The extraction of low horizontally impacted mandibular third molars presents significant surgical challenges due to their deep anatomical location adjacent to the inferior alveolar nerve canal, which increases the risk of nerve injury. The traditional chisel-and-hammer crown-splitting technique carries risks of failure and nerve damage due to uncontrollable force transmission. This paper reported a complex case involving failed traditional crown splitting, complicated by inferior alveolar nerve injury and lingual bone plate fracture. The impacted tooth was successfully removed, and nerve compression was relieved using a 30° endoscope-assisted root dislocation first approach. Postoperatively, the patient exhibited improvement in skin tightness over the lower lip and chin regions compared to preoperative assessments, with satisfactory wound healing at the surgical site. Combined with literature analysis, this study summarized the clinical advantages and technical key points of endoscopic-assisted techniques, offering a novel minimally invasive approach for the extraction of complex impacted teeth.

Key words: Endoscopy, Minimally invasive, Low horizontally impacted mandibular third molars, Inferior alveolar nerve injury