Vertical ramus compartment resection of the mandible for deeply invasive tumors

Vertical ramus compartment resection of the mandible is indicated in the management of pathology that originates in the ascending ramus or condyle of the mandible and invades the pterygomaxillary fossa, infratemporal space, parapharyngeal space, masseter muscle, or medial pterygoid muscle. This article describes the technique, presents a review of the relevant literature, and reports the outcome of five cases.

A retrospective review of all cases operated on by the senior author (R.A.O.) over the last 5 years at the University of Maryland was performed. The records of these cases were reviewed to identify patient sex, age, pathologic diagnosis, use of adjuvant therapy, and status after resection.

Five surgical cases in which a vertical ramus compartment resection of the mandible was necessary were identified. The histologic diagnoses of these five cases were as follows: grade II chondrosarcoma, peripheral neuroectodermal tumor, high-grade central mucoepidermoid carcinoma, invasive squamous cell carcinoma, and odontogenic keratocyst. Four of the five patients are alive and well at follow-up of 16 to 43 months. The only death occurred in a 70-year-old man with squamous cell carcinoma that recurred intracranially by local extension.

When indicated by local extension or tumor biology, vertical ramus compartment resection of the mandible is a viable surgical modality that allows clearance of local disease in most well-selected cases.