Juvenile Idiopathic/Rheumatoid Arthritis and Orthognatic Surgery Without Mandibular Osteotomies in the Remittent Phase

Pagnoni, Mario; Amodeo, Giulia; Fadda, Maria Teresa; Brauner, Edoardo; Guarino, G; Virciglio, Pasquale; Iannetti, Giorgio

doi:10.1097/scs.0b013e31829a8458

Cited by 24 publications

(10 citation statements)

References 14 publications

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“…The risk of surgical relapse was relatively low without any significant association with rheumatic diseases, which was consistent with previous studies (Leshem et al, 2006; Pagnoni et al, 2013; Thaller et al, 1990). At the same instance, some studies have shown a higher amount of relapse ranging from 21% to 48% following BSSO mandibular advancement in patients with juvenile idiopathic arthritis who also suffered from resorptive TMJ disorders (Oye et al, 2003; Stoor et al, 2018).…”

Section: Discussionsupporting

confidence: 91%

Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2‐year follow‐up study

Shujaat

Berne

et al. 2022

Oral Diseases

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ObjectiveThe purpose of this study was to describe the complications following orthognathic surgery in patients with rheumatic diseases and to evaluate rheumatic disease as a possible risk factor.MethodsA retrospective cohort study was conducted during a 6‐year period. The sample consisted of rheumatic and healthy patients who underwent orthognathic surgery. The outcome variables included infection, relapse, respiratory complications, hemorrhage, neurosensory disturbances, temporomandibular joint complications, and removal of osteosynthesis material. Bivariate analysis and logistic regression were applied to identify rheumatic disease as an independent risk factor for complications after orthognathic surgery.ResultsTwenty patients were identified as having rheumatic diseases (male: 2; female: 18; mean age: 37.8 ± 13.6 years), and 278 patients were systemically healthy (male: 105; female: 173; mean age: 25.8 ± 11.8 years). The most frequent complications in rheumatic and healthy patients were delayed recovery from neurosensory disturbance (55% and 33%), removal of osteosynthesis material (45% and 26%), and infection (35% and 7%). Following adjustment for possible confounders, rheumatic disease showed a significant association with infection (OR = 4.191, p = 0.016).ConclusionPatients with rheumatic diseases are at a higher risk of postoperative infection following orthognathic surgery compared to healthy patients.

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Section: Discussionsupporting

confidence: 91%

Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2‐year follow‐up study

Shujaat

Berne

et al. 2022

Oral Diseases

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“…Le Fort I osteotomy with superior repositioning of the maxilla and advancement genioplasty are considered more stable than other procedures 20. In fact, these procedures have been successfully used for effective correction of juvenile idiopathic/rheumatoid patients 21. We suggest that maxillary impaction surgery with advancement genioplasty offers a good prognosis without ingravescence of PCR.…”

Section: Discussionmentioning

confidence: 89%

A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures

et al. 2016

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We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.

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“…The optimistic hope is that if a patient's disease process is well controlled, the result will be stable. Unfortunately, this essentially can never be guaranteed, and therefore many "successes" end up being measured in the short term of months [125][126][127][128]. A patient with a process defined by condylar resorption electing to undergo orthognathic surgery alone must absolutely be informed that relapse is expected, TMJ pain and dysfunction are not expected to resolve, and only TMJ TJR will predictably result in long-term stability [129].…”

Section: Orthognathic Surgerymentioning

confidence: 99%

Temporomandibular Joint Diseases: Diagnosis and Management

2022

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Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Preface to "Temporomandibular Joint Diseases: Diagnosis and Management"The temporomandibular joint (TMJ) is capable of remodeling even after growth has stopped, allowing it to make structural changes and adapt to different physiological demands.Temporomandibular disorders (TMD) are a group of degenerative disorders involving the components of the TMJ, which can lead to displacement of the disc, joint remodeling, and eventually osteoarthritis. Different methods of diagnosis and treatments of TMD have been described in the literature in the past years. This reprint was created to provide updated information regarding all methods of diagnosis of TMD, from clinical exams to immunohistologic and molecular diagnosis and novel treatments for this disease, ranging from non-invasive techniques, such as physical therapy, ultrasound, low-level laser therapy, and splints, to surgical treatments of TMJ.

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Juvenile Idiopathic/Rheumatoid Arthritis and Orthognatic Surgery Without Mandibular Osteotomies in the Remittent Phase

Abstract: 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.

Cited by 24 publications

References 14 publications

Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2‐year follow‐up study

Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2‐year follow‐up study

A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures

Temporomandibular Joint Diseases: Diagnosis and Management

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