Abstract
Juvenile idiopathic arthritis (JIA) can create severe jaw deformities affecting function, esthetics and psychosocial health of teenagers afflicted with this disease. The aim of this chapter is to present the dentofacial manifestations of this disease and the proven surgical protocol to correct these debilitating deformities. Clinical and imaging characteristics of JIA patients with temporomandibular joint (TMJ) involvement and severe jaw deformities are presented as well as the surgical protocol to produce predictable stable outcomes. Clinical research studies documenting the efficacy of this surgical protocol will be reviewed. The most predictable, successful, and stable surgical protocol to treat JIA patients with severe dentofacial deformities includes: bilateral TMJ reconstruction and mandibular counterclockwise rotation-advancement with patient-fitted TMJ total joint prostheses (TJP) and concomitant maxillary osteotomies, as well as adjunctive procedures, performed in a single operation. This protocol provides improvement in jaw function, facial esthetics, pain, and airway. Research studies document the predictability of the treatment protocol. Case presentations illustrate the deformity and the expected outcomes with this surgical protocol. Patient-fitted TJP for TMJ and mandibular reconstruction in conjunction with maxillary orthognathic surgery provides long-term skeletal and occlusal stability in the JIA patient as well as improvement in jaw function, pain, esthetics and airway.
Highlights
Juvenile idiopathic arthritis (JIA) is an auto-immune condition and is the most common chronic joint disease in childhood
Adjunctive procedures such as genioplasty, rhinoplasty, facial augmentation, etc. This total joint prostheses (TJP) with maxillary osteotomy surgical protocol (TJP-Max-SP) used for the treatment of end-stage temporomandibular joint (TMJ) patients with dentofacial deformities was developed by Wolford in 1990[5,6] and has remained unchanged, except for placement of fat grafts around the articulating area of the prostheses added to the protocol in 1992[16,17,18]
At 21 months post-surgery, the patient exhibited good facial balance, occlusal and skeletal stability [Figure 8D-F, Figure 9D-F, Figure 10C], maximum incisal opening (MIO) increased from presurgery 43 mm to post-surgery 51 mm, significant improvement in TMJ pain (7 to 0), headaches (8 to 0), jaw function (7 to 0), diet (7 to 0), disability (6 to 0), increase of oropharyngeal airway from 1 mm presurgery to 11 mm post-surgery, and significant improvement in quality of life
Summary
Juvenile idiopathic arthritis (JIA) is an auto-immune condition and is the most common chronic joint disease in childhood. This TJP with maxillary osteotomy surgical protocol (TJP-Max-SP) used for the treatment of end-stage TMJ patients with dentofacial deformities was developed by Wolford in 1990[5,6] and has remained unchanged, except for placement of fat grafts around the articulating area of the prostheses added to the protocol in 1992[16,17,18].
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