Refers to loss of the rounded bone of the mandible located on the upper portion of the right and left mandibular ramus adjacent to the temporomandibular joint (TMJ). They consist of a neck and an elliptically shaped head or condyle that joins with the temporomandibular joint (TMJ). Loss of one or both sides of the condyloid process makes it difficult to open and close your mouth, chew food or move the jaw side to side.

Loss of the mandibular ramus may arise from severe trauma (e.g. gunshot wounds), or various disease processes such as cysts, blood vessel abnormalities or tumors, including cancer. The loss may include the portion that is part of the TMJ.

Loss of bone in the mandibular ramus results in shifting of the jaw to the affected side, and an unfavorable change in the bite relationship. This may result in facial deformity and functional limitations in chewing and speaking.

Physical examination, x-rays, and computed tomography (CT) scan are used to demonstrate abnormalities.

Treatment for ramus loss is dependent upon many factors, including: the cause of the defect, overall health of the patient, history of radiation to the area, degree of deformity and functional disturbance, and the quality of the adjacent soft tissues. There may be need for reconstruction with bone grafts, artificial materials, soft tissue procedures, and hyperbaric oxygen therapy (HBO).

If a facial deformity results from surgery or disease counseling might be needed for body image disturbance. Inability to chew or a jaw wired shut might result in nutritional deficiencies and loss of weight.

• None.

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition