S215: The Evaluation and Management of Medically Acquired Dentofacial Deformities

Abstract

Advances in medical technology have allowed many young patients with often debilitating medical conditions to lead long productive lives. However, the effects that some diseases have on facial growth may result in significant functional deficits created by developmental dentofacial deformities. The probability that the oral surgeon involved in the care of dentofacial deformities will come across this patient population is significant. Recognition of multiple minor anomalies of the face and body can give a clue as to the possibility of major organ anomalies. One must be able to recognize the impact of the medical conditions present on the ability to have a safe orthognathic surgical event. If one utilizes these diagnostic tools to learn about their patients, then corrective jaw surgery in this patient population is a predictable treatment modality. Correction of these functional deficits created by misaligned skeletal bases will have significant impact on the patient’s functional rehabilitation and quality of life. The medical conditions, such as chronic anemias, radiation induced micrognathia, rheumatoid arthritis, myotonic conditions, and ectodermal dysplasias often lead to the development of significant dentofacial deformities. The impact of these medical conditions on the surgical treatment plan as well as perioperative anesthetic management, and postoperative care will be reviewed. Evaluation and Management of Medically Acquired Dentofacial Deformities I. Review of Medical Conditions that cause Dentofacial Deformities Chronic Anemias Myotonias Ectodermal Dysplasias Radiation induced micrognathia Rheumatoid Arthritis Treatment planning for corrective jaw surgery Orthodontic considerations Osteotomy design Anesthetic Considerations Long-term issues Stability of correction Need for prosthetic management and timing References