Ossifying fibroma of mandibular ramus treated with sagittal splitting osteotomy

We treated a large, expansile lesion of the mandibular ramus in a teenage patient using a common intraoral orthognathic surgical technique rather than the more commonly employed extraoral exposure through the neck. Reasons for adopting the sagittal split osteotomy included family desire to avoid a scar, avoidance of potential pathologic fracture through the thinned lingual cortex and inferior border, avoidance of possible significant removal of very thick buccal cortex and avoidance of intermaxillary fixation. The exposure was adequate to completely remove a potentially aggressive lesion with relatively brief OR time. There has been no sign of recurrence in over three years of follow-up. There have been occasional references to the use of sagittal split osteotomy of the mandibular ramus to gain access to lesions of this area. This short case report is offered to support and, perhaps, encourage its use in appropriate situations.