Juvenile idiopathic/rheumatoid arthritis and orthognatic surgery without mandibular osteotomies in the remittent phase.
BACKGROUND
Orthognathic treatment of patients with juvenile idiopathic/rheumatoid arthritis is still controversial. Mandibular procedures may result in relapse and further condylar resorption and pain. Maxillary osteotomies and genioplasty may be effective for the correction of malocclusion and for aesthetics.


METHODS
Five patients with juvenile idiopathic/rheumatoid arthritis with severe temporomandibular joint (TMJ) involvement underwent orthognathic surgery with a simultaneous Le Fort I osteotomy and advancement genioplasty. The age of the patients at the time of surgery ranged between 17 and 29 years (mean, 21.75 years). The patients were under follow-up for a minimum of 8 months after surgery, and measurements were performed using Dolphin 3D imaging.


RESULTS
All 5 patients have an improved occlusion and improved facial aesthetics. The mean mandible rotation advancement was 5.6 mm (range, 4 to 7 mm). The mean posteroanterior face height ratio (S-Go/N-Me) after surgery was 63.9 (range, 62.9 to 65.8). No exacerbation of the juvenile rheumatoid arthritis was encountered as a result of the surgical procedure.


CONCLUSIONS
Le Fort I osteotomy with impaction and advancement genioplasty are effective procedures for occlusal and aesthetic correction of juvenile idiopathic/rheumatoid patients. Mandibular procedures may evoke further condylar resorption with pain and functional impairment of the TMJ.
From the Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.
Mario
M
Pagnoni
Giulia
G
Amodeo
Maria Teresa
MT
Fadda
Edoardo
E
Brauner
Giorgio
G
Guarino
Pasquale
P
Virciglio
Giorgio
G
Iannetti
D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000150:complications*; D001862:Bone Resorption / Q000209:etiology; D002508:Cephalometry / Q000379:methods; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008310:Malocclusion / Q000209:etiology / Q000601:surgery*; D008335:Mandibular Condyle / Q000473:pathology; D008336:Mandibular Diseases / Q000209:etiology; D008437:Maxilla / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D013705:Temporomandibular Joint Disorders / Q000150:complications*; D055815:Young Adult