Indication to extract deep impacted teeth as well as the surgical approaches is controversally discussed in the litterature. Based on a clinical case report we describe two atypical approaches, one is extraoral the other lingual for removing tow deeply impacted teeth. The revue of the litterature shows that atypical surgical approaches are only indicated in particular clinical situations. The indication to remove the teeth and the approach depends on the patient's compliance as well as the experience of the operator. In the reported case the extraoral approach is justified by the chronical dentogene infection with fistulisation and cutaneus changes in the submandibular region. Based on the much easier access to the tooth and the only minimal cutaneus modifications in this case, we recommand the extraoral approach for extraction of deep impacted teeth in some special cases like the one we present.