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

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

doi: 10.1097/SCS.0b013e31829a8458
Clinical Studies

Background Orthognathic treatment of patients with juvenile idiopathic/rheumatoid arthritis is still controversial. Mandibular procedures may result in relapse and further condylar resorption and pain. Maxillary osteotomies and genioplasty may be effective for the correction of malocclusion and for aesthetics.

Patients and Methods Five patients with juvenile idiopathic/rheumatoid arthritis with severe temporomandibular joint (TMJ) involvement underwent orthognathic surgery with a simultaneous Le Fort I osteotomy and advancement genioplasty. The age of the patients at the time of surgery ranged between 17 and 29 years (mean, 21.75 years). The patients were under follow-up for a minimum of 8 months after surgery, and measurements were performed using Dolphin 3D imaging.

Results All 5 patients have an improved occlusion and improved facial aesthetics. The mean mandible rotation advancement was 5.6 mm (range, 4 to 7 mm). The mean posteroanterior face height ratio (S-Go/N-Me) after surgery was 63.9 (range, 62.9 to 65.8). No exacerbation of the juvenile rheumatoid arthritis was encountered as a result of the surgical procedure.

Conclusions 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.

From the Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy.

Received February 2, 2013.

Accepted for publication March 25, 2013.

Address correspondence and reprint requests to Dr Giulia Amodeo, Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Via del Giordano 33, 00144, Rome, Italy; E-mail:

The authors report no conflicts of interest.

© 2013 by Mutaz B. Habal, MD.