Surgical correction of the severe jaw deformity in teenagers with juvenile idiopathic arthritis

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.

Keywords

Juvenile idiopathic arthritis / temporomandibular joint / oropharyngeal airway / sleep apnea / temporomandibular joint concepts / temporomandibular joint total joint prosthesis / condylar resorption

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