Management of severe sleep apnea secondary to juvenile arthritis with temporomandibular joint replacement and mandibular advancement

Paul, S Arun; Simon, Sibu S; Issac, Barney; Kumar, Saurav

doi:10.4103/0975-7406.163479

Cited by 13 publications

(7 citation statements)

References 15 publications

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“…With regards to treatment of OSA with concomitant TMJ disease, reports of mandibular advancement with simultaneous bilateral TMJ replacement have been reported successfully (22). In this case, computed tomography (CT) showed that the condylar hypoplasia, resultant micrognathia, and decreased retrolingual and retropharyngeal airway space were all significantly improved with the surgical procedures.…”

Section: The Relationship Between Osa and Tmj Diseasementioning

confidence: 84%

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

Movahed¹,

Semensohn²

2023

Front Oral Maxillofac Med

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Temporomandibular disorders, specifically those that affect the joint anatomy and condylar morphology, can have a deleterious effect on patients with obstructive sleep apnea (OSA). There is a correlation that has emerged between OSA and temporomandibular joint (TMJ) diseases, whether the former influenced that latter or vice versa is of some debate. What is discussed, in this review, is that as the condyle resorbs it can have significant influence on the airway. More specifically, the volume and architecture of the upper airway can decrease in size and pose a threat to breathing. With a narrowed, or constricted airway, the propensity for airway collapse increases, thus leading to or developing into a sleep apnea. OSA as an entity unto itself can lead to significant cardiovascular and other systemic effects that can become morbid if not addressed. Given this, multiple treatments have been aimed at correcting the insult. It is also established that maxillomandibular advancement (MMA) surgery can greatly improve symptoms in patients with OSA, with safe, stable, and predictable results. This procedure achieves its goals by reconstructing the upper airway in such a manner that airflow is no longer just impeded but also aided. However, the traditional bimaxillary surgery alone may be insufficient especially in the setting of concomitant TMJ disease. This review will describe and discuss the indications wherein TMJ total joint replacement (TJR) surgery combined with MMA can also lead to similar predictive and stable results.

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Section: The Relationship Between Osa and Tmj Diseasementioning

confidence: 84%

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

Movahed¹,

Semensohn²

2023

Front Oral Maxillofac Med

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“…63 Of 5 case series of TJR that included patients with JIA, all reported positive outcomes. [64][65][66][67][68] It must be noted, however, that the long-term stability of autologous and alloplastic constructs has never been directly compared.…”

Section: E29mentioning

confidence: 99%

An Algorithm for Management of Dentofacial Deformity Resulting From Juvenile Idiopathic Arthritis: Results of a Multinational Consensus Conference

Resnick

Frid

Nørholt

et al. 2019

Journal of Oral and Maxillofacial Surgery

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“…The temporomandibular joint (TMJ) is one of the most commonly involved joints in children with juvenile idiopathic arthritis (JIA), and may lead to impaired joint function, pain, growth impairment with dentofacial deformities [ 1 – 4 ], a reduced posterior airway space with related comorbidities [ 5 , 6 ], and impaired quality of life [ 7 ]. The rate of TMJ arthritis varies significantly (40–90%) in different JIA-cohorts using magnetic resonance imaging (MRI) [ 8 – 10 ], as reviewed by Larheim et al [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study

et al. 2020

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Background Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting. Methods In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation. Results Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent. Conclusions In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.

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Management of severe sleep apnea secondary to juvenile arthritis with temporomandibular joint replacement and mandibular advancement

Cited by 13 publications

References 15 publications

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

An Algorithm for Management of Dentofacial Deformity Resulting From Juvenile Idiopathic Arthritis: Results of a Multinational Consensus Conference

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study

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