Case description: A male patient with 26 years-old attended the Dental Medicine appointment with a clinical history of abscess acute episodes, edema of the right hemi-face, diffuse pains, limited mouth opening. Were performed clinical examination and imaging studies (computed tomography and panoramic radiography); Diagnosed revelled impactation of 48 tooth with extensive periapical lesion associated. Therapeutic and prophylactic medication (antibiotics, NSAIDs and anti-inflammatory/corticosteroids) assessment was done. After 12 days, surgical extraction intervention was carried out, which technique is described step by step. Discussion: In Europe the occurrence of third molar teeth impaction reaches 73% young adults. This impaction can occur in different ways and their surgery may have different levels of difficulty, thus differentiating their therapeutic and surgical approaches. Surgical extraction of impacted teeth may, iatrogenic complications such as lesions of the inferior alveolar and/or lingual nerve and disorders in neurosensory functions, paresthesia, numbness or pain in the affected area of the skin region, gingival lower lip, mucous membranes and gums. Conclusion: The planning of surgical extractions of impacted 3rd molars associated with chronic pathology is essential to prevent postoperative complications. The prescription of complementary diagnostic procedures are crucial for surgical planning, as the anatomical knowledge in order to make possible the most predictable outcome, improving the intervention prognosis. Keywords: impacted third molar teeth, lingual nerve, inferior alveolar nerve, chronic periapical pathology, surgical extraction, diagnosis, planning