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Krarup H, Pedersen TK, Frid P, Nørholt SE. Long-term follow-up of corrective jaw surgery including distraction osteogenesis in 32 patients with juvenile idiopathic arthritis. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00182-6. [PMID: 38945734 DOI: 10.1016/j.ijom.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Dentofacial deformity following juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement is associated with functional, aesthetic, and psychosocial impairment. Corrective surgical treatment includes combinations of orthognathic surgeries (OS). The aims of this study were to assess orofacial symptoms, functional and aesthetic status, and stability after OS including mandibular distraction osteogenesis (MDO). A prospective study was conducted of 32 patients with JIA of the TMJ and dentofacial deformities who underwent MDO as the only surgery or in combination with bilateral sagittal split osteotomy, Le Fort I, and/or genioplastybetween 2003 and 2018. Data from clinical examinations and cephalograms performed pre- and postoperative and at long-term (mean 4 years) were analysed. Patients experienced unchanged orofacial symptoms (all P > 0.05), short-term TMJ functional impairment (all P < 0.001), and long-term morphological improvements in SNB angle (P < 0.001), anterior facial height (P < 0.001), mandibular length (P = 0.049), overjet (P < 0.001 and P = 0.005), and posterior facial symmetry (P = 0.046). MDO as the only surgery or with secondary adjunctive OS improved dentofacial morphology in terms of mandibular advancement, anterior facial height, posterior facial symmetry, and incisal relationships without long-term deterioration in TMJ function or orofacial symptoms.
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Affiliation(s)
- H Krarup
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - T K Pedersen
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - P Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway; Public Dental Service Competence Centre of North Norway, Tromsø, Norway; Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
| | - S E Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; Section for Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Costello A, Twilt M, Lerman MA. Provider assessment of the temporomandibular joint in Juvenile idiopathic arthritis: a retrospective analysis from the CARRA database. Pediatr Rheumatol Online J 2024; 22:41. [PMID: 38589909 PMCID: PMC11000332 DOI: 10.1186/s12969-024-00968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) involvement is an often underrecognized complication of juvenile idiopathic arthritis (JIA) that can cause decreased mandibular growth, altered facial morphology, and orofacial pain. It is estimated that the TMJ is affected in 30-45% of children with JIA. Standardized physical examination and imaging evaluations are important in accurately assessing active TMJ arthritis and sequalae. Little is known about the rate at which providers evaluate TMJ involvement in their clinical practice. METHODS Data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Data fields related to assessment for TMJ arthritis were added in 2019. Patients were included in the study if they had a diagnosis of JIA and had data recorded between January 2020 and August 2021. Standard descriptive statistics were used to describe demographic and clinical features. RESULTS A total of 17,761 visits were reviewed for a total of 7473 patients with JIA. A total of 52.7% of patients had maximal mouth opening (MMO) recorded as finger breadths or total incisal distance (TID). Only 8% had TID measured. A total of 5.0% had MRI with contrast performed. A total of 939 patients had a diagnosis of TMJ arthritis. Of these, 28.5% had an MRI documented, 83% had an MMO documented, and 40% had TID measured. Few patient-level characteristics were statistically related to having MMO assessed. MRI was more likely to be obtained in older and in female patients. MMO was recorded at a given visit > 80% of the time at 17 sites, and it was recorded < 1% of the time at 8 sites. MRIs were infrequently performed at all sites, with 27 sites having no MRIs obtained and only 7 sites having an MRI obtained at > 10% of visits. CONCLUSIONS MMO is not consistently measured in patients with JIA, and it is rarely measured quantitatively. Similarly, TMJ MRIs are rarely obtained in patients with JIA. Site of care is more associated with TMJ assessments than patient-level characteristics. These data suggest that provider education is needed to improve the assessment of the TMJ in patients with JIA to enable earlier recognition and prevent long-term complications.
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Affiliation(s)
- Anna Costello
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Marinka Twilt
- Department of Pediatrics, Division of Rheumatology, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Melissa A Lerman
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
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Krarup H, Pedersen TK, Frid P, Nørholt SE. Long-Term Follow-Up of Orthognathic Surgery in 19 Patients with Juvenile Idiopathic Arthritis. J Oral Maxillofac Res 2023; 14:e4. [PMID: 38222878 PMCID: PMC10783879 DOI: 10.5037/jomr.2023.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 01/16/2024]
Abstract
Objectives Dentofacial deformity following juvenile idiopathic arthritis with temporomandibular joint involvement is associated with functional, aesthetic, and psychosocial impairment. Surgical treatment may involve combinations of orthognathic surgery. The aims of this retrospective study were to assess orofacial symptoms, functional and aesthetic status, and stability after orthognathic surgery. Material and Methods Nineteen patients with juvenile idiopathic arthritis of the temporomandibular joint (TMJ) and dentofacial deformities were included. All patients were treated with combinations of bilateral sagittal split osteotomy, Le Fort I and/or genioplasty, between September 10, 2007 and October 17, 2017. Analysis of patient symptoms and clinical registrations, and frontal/lateral cephalograms was performed pre- and postoperative and long-term (mean: 3.8 and 2.6 years, respectively). Results Patients experienced no changes in orofacial symptoms or TMJ function, and stable normalisation of horizontal and vertical incisal relations at long-term (horizontal overbite; vertical overbite: P < 0.05). Mandibular lengthening was achieved postoperatively (from mean 79.7 to 87.2 mm; P = 0.004) and was stable. Sella-nasion to A point (SNA) and sella-nasion to B point (SNB) angles increased postoperatively (SNA, mean 79.9° to 82.8°; P = 0.022 and SNB, mean 73.9° to 77.8°; P = 0.003), however, largely reverted to preoperative status at long-term. Conclusions Orthognathic surgery normalized incisal relations while providing stable mandibular lengthening without long-term deterioration of temporomandibular joint function or orofacial symptoms. No long-term effect on jaw advancements was observed.
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Affiliation(s)
- Henrik Krarup
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
| | - Thomas Klit Pedersen
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
- Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, AarhusDenmark.
| | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, TromsøNorway.
- Public Dental Service Competence Centre of North Norway, TromsøNorway.
- Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø
Norway.
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
- Section for Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, AarhusDenmark.
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Wroclawski C, Mediratta JK, Fillmore WJ. Recent Advances in Temporomandibular Joint Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1409. [PMID: 37629699 PMCID: PMC10456345 DOI: 10.3390/medicina59081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.
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Affiliation(s)
| | - Jai Kumar Mediratta
- Resident, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - W. Jonathan Fillmore
- Consultant, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, Koos B, Verna C, Nordal EB, Granquist EJ, Halbig JM, Kristensen KD, Kaban LB, Arvidsson LZ, Spiegel L, Stoll ML, Lerman MA, Glerup M, Defabianis P, Frid P, Alstergren P, Cron RQ, Ringold S, Nørholt SE, Peltomaki T, Larheim TA, Herlin T, Peacock ZS, Kellenberger CJ, Twilt M. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75:4-14. [PMID: 36041065 PMCID: PMC10100353 DOI: 10.1002/art.42338] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.
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Affiliation(s)
| | - Cory M. Resnick
- Department of Plastic and Oral SurgeryBoston Children's HospitalBostonMassachusetts
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and PediatricsEmory University School of MedicineAtlantaGeorgia
| | - Thomas K. Pedersen
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | | | - Annelise Küseler
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Bernd Koos
- Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
| | - Carlalberta Verna
- Department of Pediatric Oral Health and OrthodonticsUZB University Center for Dentistry Basel, University of BaselBaselSwitzerland
| | - Ellen B. Nordal
- Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Eric J. Granquist
- Department of Oral and Maxillofacial Surgery, School of Dental MedicineUniversity of PennsylvaniaPhiladelphia
| | - Josefine Mareile Halbig
- The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | | | - Leonard B. Kaban
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | - Linda Z. Arvidsson
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Lynn Spiegel
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Melissa A. Lerman
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvania
| | - Mia Glerup
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | | | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical DentistryUiT The Arctic University of NorwayTromsøNorway
| | - Per Alstergren
- Faculty of Odontology, Orofacial Pain UnitMalmö UniversityMalmöSweden
| | | | | | - Sven Erik Nørholt
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Timo Peltomaki
- Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University HospitalKuopioFinland
| | - Tore A. Larheim
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Troels Herlin
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | - Zachary S. Peacock
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | | | - Marinka Twilt
- Alberta Children's Hospital and University of CalgaryCalgaryAlbertaCanada
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Kinard BE, Behlen VH, Kau CH, Waite PD. Is Orthognathic Correction with TMJ Preservation A Stable Treatment Option for Patients with Juvenile Idiopathic Arthritis? J Maxillofac Oral Surg 2022; 21:1286-1290. [PMID: 36896060 PMCID: PMC9989086 DOI: 10.1007/s12663-022-01714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the long-term skeletal stability of orthognathic correction of dentofacial deformities secondary to juvenile idiopathic arthritis (JIA) in individuals without total alloplastic joint reconstruction. Materials and Methods The investigators designed and implemented a retrospective case series of patients diagnosed with JIA who underwent bimaxillary orthognathic surgery. To evaluate the long-term skeletal changes, the maxillary palatal plane to mandibular plane angle, anterior facial height, and posterior facial height measurements were evaluated through cephalograms. Results Six patients met inclusion criteria. All subjects were female (mean 16.2 years). Four patients demonstrated < 1° of change of the palatal plane to mandibular plane angle, and all patients had < 2° of change. Three patients had < 1% change in the anterior to posterior facial height ratio. Three patients demonstrated relative posterior facial shortening compared to anterior facial height (< 4%). No patients developed postoperative anterior open-bite malocclusion. Conclusion Orthognathic correction of the JIA DFD deformity with TMJ preservation is a viable modality to improve facial esthetics, occlusion, upper airway and speech swallowing and chewing mechanisms in select patients. The measured skeletal relapse did not affect the clinical outcome.
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Affiliation(s)
- Brian E. Kinard
- Department of Oral and Maxillofacial Surgery, Department of Orthodontics, School of Dentistry, University of Alabama, 1919 7th Ave S, SDB 419, Birmingham, 35294-0007 AL USA
| | | | - Chung H. Kau
- Department of Orthodontics, School of Dentistry, University of Alabama, Birmingham, USA
| | - Peter D. Waite
- Department of Oral and Maxillofacial Surgery, University of Alabama, Birmingham, USA
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Henry A, Mehra P. Reconstruction of the TMJ and condyle in inflammatory arthritis. J Oral Biol Craniofac Res 2022; 12:623-632. [PMID: 36035810 PMCID: PMC9403565 DOI: 10.1016/j.jobcr.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/05/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.
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Affiliation(s)
- Andrew Henry
- Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Abstract
Arthritis is a common condition affecting millions of people in the UK and worldwide. All members of the dental team will be seeing and treating patients with this condition, and it is important to understand the disease, its management and medications used. This article outlines the five most common types of arthritis: osteoarthritis (OA), rheumatoid arthritis (RA), axial spondyloarthritis (sPA), juvenile idiopathic arthritis (JIA), and gout. It further discusses the medications used to treat these conditions and any dental implications. Finally, advice is offered on considerations for the dental team when treating such patients.
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Affiliation(s)
| | - Matthew Chia
- Consultant Orthodontist, Clinical Lead Orthodontics & Restorative Dentistry, Croydon University Hospital, London, UK
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10
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Schmidt C, Ertel T, Arbogast M, Hügle B, Kalle TV, Neff A. Clinical Practice Guideline: The Diagnosis and Treatment of Rheumatoid Arthritis and Juvenile Idiopathic Arthritis of the Temporomandibular Joint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:47-54. [PMID: 34874262 DOI: 10.3238/arztebl.m2021.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Involvement of the temporomandibular joint can be shown in 40-90% of patients with rheumatoid arthritis and juvenile idiopathic arthritis (JIA), although it is often asymptomatic. Restricted jaw mobility and jaw pain can be found in approximately 20% of patients with JIA (prevalence: 70 per 100 000 persons). Early diagnosis and treatment of the underlying disease are essential for a good outcome, but uniform, consensus-based management is still lacking. METHODS The clinical practice guideline is based on the findings of a systematic literature review in multiple databases and a Delphi procedure to obtain consensus on the recommendations. RESULTS Most of the identified studies were retrospective. Patients with JIA should undergo clinical screening with a structured examination protocol once per year in childhood and adolescence, and thereafter as well if the temporomandibular joint is involved. The diagnosis of chronic rheumatoid arthritis of the temporomandibular joint is established with contrastenhanced magnetic resonance imaging. Conservative treatment (antirheumatic basal therapy, local measures) is unsuccessful in less than 10% of patients. In such cases, arthroscopy and arthrocentesis can be used for temporary symptom relief and functional improvement. Intraarticular corticosteroid injections should be given only once, and only in otherwise intractable cases. In severe cases where all other options have been exhausted (<1%), open surgical treatment can be considered, including alloplastic joint replacement. CONCLUSION Oligosymptomatic and asymptomatic cases are common even with radiologic evidence of marked joint damage. The possibility of rheumatic involvement of the temporomandibular joint must be kept in mind so that serious complications can be avoided. Regular clinical evaluation of the temporomandibular joint is recommended, particularly for patients with juvenile idiopathic arthritis.
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Abstract
Patients with juvenile idiopathic arthritis (JIA) often have involvement of the temporomandibular joint (TMJ) during their disease course. Active arthritis of the TMJ remains difficult to assess. Clinical signs and symptoms alone are unreliable, and active TMJ arthritis needs confirmation by gadolinium-enhanced MRI. In recent years, changes in treatment approach have occurred. This article discusses the latest evidence on diagnosis and treatment of JIA-associated TMJ arthritis.
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Trivedi B, Wolford LM, Kesterke MJ, Pinto LP. Does Combined Temporomandibular Joint Reconstruction With Patient Fitted Total Joint Prosthesis and Orthognathic Surgery Reduce Symptoms in Juvenile Idiopathic Arthritis Patients? J Oral Maxillofac Surg 2021; 80:267-275. [PMID: 34666035 DOI: 10.1016/j.joms.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients with juvenile idiopathic arthritis (JIA) and TMJ involvement may have major dentofacial deformities, pain, and jaw dysfunction. The aim of this study was to evaluate surgical outcomes for JIA patients relative to TMJ pain, headache, jaw function, diet, disability, and quality-of-life (QOL) after TMJ reconstruction with patient-fitted total joint prostheses (TJP) and concomitant orthognathic surgery. METHODS A retrospective cohort study was conducted on a JIA patient group (JIAG) with significant dentofacial deformity, reconstructed with TJP and concomitant orthognathic surgery, and was compared to a control group (CG) of non-JIA patients that received the same surgical protocol with similar surgical movements. Primary predictors were the 2 groups: JIAG and CG. Data were evaluated and compared presurgery and at longest follow-up using Likert analog scales for the primary variables: TMJ pain, headache, jaw function, diet, and disability. Maximum interincisal opening (MIO) was measured in mm. QOL was rated in JIAG as improved, same, or worse. Comparative data were tested for significance (α = 0.05) using Wilcoxon signed rank and paired T-tests. RESULTS Forty JIAG patients (8 males, 32 females) met the inclusion criteria, median age 17.5 years, median follow-up 26.5 months, and 26 CG patients (1 male, 25 females), median age 35.5 years, follow-up 24 months. Significant improvements (P ≤ .05) occurred postsurgery for TMJ pain, headache, jaw function, diet, and disability for both groups. Mean increase MIO for JIAG was 36.4 to 43.3 mm, for CG was 35.2 to 37.8 mm. Thirty-eight JIA patients (95%) improved in QOL, 2 had no change, and none were worse. CONCLUSIONS This study suggests that patient-fitted TJP for TMJ reconstruction in conjunction with orthognathic surgery for the JIA patient provides long-term improvement relative to TMJ pain, headache, jaw function, diet, disability, MIO, and QOL.
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Affiliation(s)
- Bhavin Trivedi
- Oral and Maxillofacial Surgeon, Dental Corps, United States Navy, Portsmouth, VA; Former Resident, Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX
| | - Larry M Wolford
- Clinical Professor, Departments or Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Dallas, TX.
| | - Matthew J Kesterke
- Assistant Professor, Department of Biomedical Sciences, Texas A&M College of Dentistry, Dallas, TX
| | - Lecio Pitombeira Pinto
- Former Fellow, Departments or Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX; Chairman, Department of Oral and Maxillofacial Surgery, Fortaleza General Hospital, Fortaleza, Ceará, Brazil
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Tominna M, Vega-Fernandez P, McLaurin W, Meyers AB. Imaging of the Pediatric Temporomandibular Joint. Semin Roentgenol 2021; 56:307-324. [PMID: 34281682 DOI: 10.1053/j.ro.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marie Tominna
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Wallace McLaurin
- Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Sarlabous M, El-Rabbany M, Caminiti M, Psutka DJ. Alloplastic Temporomandibular Joint Replacement in Patients With Systemic Inflammatory Arthritis and Connective Tissue Disorders. J Oral Maxillofac Surg 2021; 79:2240-2246. [PMID: 34119479 DOI: 10.1016/j.joms.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/17/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We present a retrospective study to report the outcomes of total temporomandibular joint (TMJ TJR) replacement with alloplastic devices in patients suffering from systemic inflammatory arthropathies. METHODS A total of 39 patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile idiopathic rheumatoid arthritis (JIA), or systemic lupus, underwent alloplastic total joint replacement(s) (TJR) from 1999 to 2019. Maximal interincisal opening (in mm) was recorded before surgery (T0), at 1-year post-surgery (T1) and at last follow-up (T2). A visual analog scale (from 0 to 10) was used for subjective examination of pain before surgery (T0) and at last follow-up (T2). Comparisons were conducted with statistical significance set at P < .05. RESULTS Seventy-four joints were replaced in 39 patients. Thirty-two were female. The mean age was 36 years old (range 18-61) and the mean follow-up was 45.9 months (SD 49.4). The most common diagnosis was RA (n = 21), followed by JIA (n = 5) and AS (n = 5), PA (n = 4), lupus (n = 3), and mixed connective tissue disorder (n = 1). The mean pain score had fallen from 6.8 (SD 3.2) at T0 to 1.3 (SD 2.4) (P < .001) at T2. The maximal interincisal opening had improved from a mean of 22.1 mm (SD 13.3) at T0 to 34.3 mm (SD 8.5) (P < .001) at T2. One patient got persistent dysesthesia in the V3 distribution. There were no serious late complications. CONCLUSION Patients suffering from systemic inflammatory arthropathies involving the TMJs can be successfully treated by TJR with alloplastic devices. The long-term reduction of TMJ symptoms and functional improvement in this initial study suggest good predictability for this treatment.
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Affiliation(s)
- Mathilde Sarlabous
- Attending Oral and Maxillofacial Surgeon and director, TMJ Surgery Program, Laval University, Quebec City. Canada; Co-founder, Sinai Health System Centre for Excellence in TMJ Surgery.
| | | | - Marco Caminiti
- Assistant professor and Head, University of Toronto Oral and Maxillofacial Surgery Program, Toronto, Canada; Co-director, University of Toronto Fellowship Program in Advanced TMJ and Orthognathic Surgery; Director, University of Toronto Centre for Advanced Jaw Surgery; Chief, Department of Oral and Maxillofacial Surgery, Humber River Regional Hospital, Toronto, Canada
| | - David J Psutka
- Assistant Professor, University of Toronto Department of Oral and Maxillofacial Surgery; Co-founder, Sinai Health System Centre for Excellence in TMJ Surgery; Co-director, University of Toronto Fellow ship Program in Advanced TMJ and Orthognathic Surgery
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15
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Juvenile idiopathic arthritis of the temporomandibular joint - no longer the forgotten joint. Br J Oral Maxillofac Surg 2021; 60:247-256. [PMID: 35249742 DOI: 10.1016/j.bjoms.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
Juvenile idiopathic arthritis (JIA) of the temporomandibular joint (TMJ) is common in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment, as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast magnetic resonance imaging (MRI). Long-term management is best provided by a multidisciplinary team as patients often need a combination of pharmacological management, surgical interventions, orthodontics, and psychological support. End stage deformity can be treated by different surgical options, each with their own risks and benefits, however recently there is increasing recognition for the role of total alloplastic TMJ replacement. This review focuses on the diagnosis and management of TMJ arthritis and aims to highlight the important role of maxillofacial surgeons in JIA treatment.
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16
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Bridges JM, Mellins ED, Cron RQ. Recent progress in the treatment of non-systemic juvenile idiopathic arthritis. Fac Rev 2021; 10:23. [PMID: 33718940 PMCID: PMC7946384 DOI: 10.12703/r/10-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease affecting the joints and other organs that occurs in 1 in 1,000 children in the United States. Given the various categories of JIA, interpretation of the literature can be difficult. In this review, new developments in understanding non-systemic JIA and its treatment will be covered. Recent advances in the journey toward personalized treatment in JIA will be highlighted, including a review of currently available biologic modifiers. Uveitis and the temporomandibular joint will be discussed as particularly challenging treatment issues. Recent guideline updates and literature-guided treatment decisions will be reviewed.
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Affiliation(s)
- John M Bridges
- Children’s of Alabama/University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, California, USA
| | - Randy Q Cron
- Children’s of Alabama/University of Alabama at Birmingham, Birmingham, Alabama, USA
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17
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Comparing Clinical and Radiological Manifestations of Adolescent Idiopathic Condylar Resorption and Juvenile Idiopathic Arthritis in the Temporomandibular Joint. J Oral Maxillofac Surg 2020; 79:774-785. [PMID: 33217307 DOI: 10.1016/j.joms.2020.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE This cross-sectional study compared orofacial manifestations at the time of diagnosis in 2 temporomandibular joint (TMJ) conditions: adolescent idiopathic condylar resorption (ICR) and TMJ involvement from juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS This retrospective study included 19 JIAs, 19 ICRs, and 19 control patients, all treated at the Section of Orthodontics, Aarhus University Craniofacial Clinic, Denmark. From patient files, we retrieved radiological data from cone-beam computed tomographies along with information on symptoms and orofacial function at the time of diagnosis. Validated methodologies were used to evaluate TMJ and dentofacial morphology. RESULTS We found no statistically significant intergroup differences in severity of deformation of TMJ structures (TMJ deformity) between JIA and ICR patients. However, the ICR group showed significantly greater signs of dentofacial deformity on 4 outcome variables: mandibular inclination, posterior/anterior lower face height ratio, mandibular sagittal position, and mandibular occlusal plane inclination. Significant intergroup differences in clinical presentation were seen in 5 of 20 variables. Thus, the JIA group reported significantly more symptoms of TMJ pain, TMJ morning stiffness, and TMJ pain on palpation during the clinical examination, whereas the ICR group reported significantly more TMJ clicking during function and had a higher proportion of patients with anterior open bite. CONCLUSIONS Cone-beam computed tomography examination showed a similar degree of TMJ deformity in ICR and JIA patients at the time of diagnosis. ICR patients presented with a significantly higher degree of dentofacial deformity than JIA patients and healthy controls, which relates to the timing of the diagnosis. Arthralgia, TMJ morning stiffness, and TMJ palpitation pain were more common in JIA patients, whereas TMJ clicking during function and anterior open bites were more common in ICR patients.
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18
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Frid P, Augdal TA, Larheim TA, Halbig J, Rypdal V, Songstad NT, Rosén A, Tylleskär KB, Berstad JR, Flatø B, Stoustrup P, Rosendahl K, Kirkhus E, Nordal E. 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. Pediatr Rheumatol Online J 2020; 18:75. [PMID: 32998740 PMCID: PMC7528594 DOI: 10.1186/s12969-020-00464-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
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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Affiliation(s)
- Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway.
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Thomas A Augdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Tore A Larheim
- Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Veronika Rypdal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karin B Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Johanna Rykke Berstad
- Department of ENT and Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Karen Rosendahl
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Ellen Nordal
- Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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Lypka M, Shah K, Jones J. Prosthetic temporomandibular joint reconstruction in a cohort of adolescent females with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2020; 18:68. [PMID: 32887620 PMCID: PMC7487714 DOI: 10.1186/s12969-020-00453-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) arthritis and involvement is commonly seen in Juvenile Idiopathic Arthritis (JIA). Therapy includes conservative measures, but also includes intraarticular corticosteroid injections (IASI) and systemic immunosuppressive therapy. Despite aggressive medical therapy, some patients develop arthritic changes and frank TMJ ankylosis that can result in persistent pain and limitation in range of motion (ROM). A surgical option is prosthetic TMJ replacement with concurrent correction of dentofacial deformities, which can be performed simultaneously. The objective of this study was to evaluate the outcomes of prosthetic TMJ replacement in a cohort of adolescent females with JIA and severe TMJ involvement. METHODS This is a retrospective case series that took place at one tertiary care center. Patients with a diagnosis of JIA who also underwent alloplastic TMJ replacement were identified through electronic medical record system (EMR) and reviewed. Chart review included analysis of all documents in the EMR, including demographic data, JIA history, surgical complications, ROM of TMJ measured by maximal incisal opening in millimeters (mm) and TMJ pain scores (4-point Likert scale: none, mild, moderate, severe) obtained pre- and postoperatively. RESULTS Five female patients, ages 15-17 year when TMJ replacement was performed, had nine total joints replaced with a post-operative follow-up period of 12-30 months. All patients had polyarticular, seronegative JIA and were treated with IASI and multiple immunosuppressive therapies without resolution of TMJ symptoms. One patient had bilateral TMJ ankylosis. Three of the five patients demonstrated significant dentofacial deformities, and all underwent simultaneous or staged orthognathic surgery. All patients had improvement in TMJ pain with most (80%) reporting no pain, and all had similar or improved ROM of their TMJ postoperatively. There was one delayed postoperative infection with Cutibacterium Acnes that presented 15 months after surgery and required removal and reimplantation of prosthesis. CONCLUSION The sequelae of TMJ arthritis and involvement from JIA in the adolescent population can be difficult to treat. Current medical therapy can be successful, however, in select cases that develop chronic changes in the TMJ despite extensive medical therapy, early results show that prosthetic joint replacement maybe a reasonable surgical option. With prosthetic joint replacement pain levels were reduced and range of motion was maintained or improved for all patients.
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Affiliation(s)
- Michael Lypka
- Division of Plastic and Craniofacial Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA.
| | - Karina Shah
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - Jordan Jones
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA ,grid.239559.10000 0004 0415 5050Division of Rheumatology, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 USA
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20
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Brown Z, Rushing DC, Perez DE. Alloplastic Temporomandibular Joint Reconstruction for Patients With Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2020; 78:1492-1498. [PMID: 32540323 DOI: 10.1016/j.joms.2020.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to assess the efficacy of alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) in patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS All patients with a formal diagnosis of JIA requiring a TMJ patient-specific TJR between 2010 and 2018 at The University of Texas-Health at San Antonio were retrospectively analyzed. To be included, patients must have had a formal diagnosis of JIA, complete records, and TMJ reconstruction with the TMJ Concepts patient-specific total joint prosthesis (TMJ Concepts, Ventura, CA). Clinical data acquisition was required at a minimum of 12 months after surgery (longest follow-up [LFU]). Subjective and objective analyses were performed using a 10-point visual analog scale at the preoperative and LFU time points. Surgical data at the perioperative and LFU time points were recorded for comparison. RESULTS Twenty patients with JIA met the inclusion criteria. The mean visual analog scale measurements for facial pain, TMJ pain, jaw function, diet, and disability were all significantly reduced at LFU. The maximal interincisal opening with pain was increased from 33.5 mm preoperatively to 44 mm at LFU, and the mean maximal interincisal opening without pain was increased from 31.1 mm preoperatively to 43 mm at LFU. None of the patients had complications from their TMJ TJR. CONCLUSIONS Alloplastic TMJ reconstruction is a safe and efficacious treatment option for the surgical management of end-stage TMJ disease in JIA patients.
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Affiliation(s)
- Zachary Brown
- Resident, Oral and Maxillofacial Surgery Department, The University of Texas-Health at San Antonio, San Antonio, TX
| | - Denae C Rushing
- Resident, Oral and Maxillofacial Surgery Department, The University of Texas-Health at San Antonio, San Antonio, TX
| | - Daniel E Perez
- Program Director,Oral and Maxillofacial Surgery Department, The University of Texas-Health at San Antonio, San Antonio, TX.
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21
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Stoustrup P, Pedersen TK, Nørholt SE, Resnick CM, Abramowicz S. Interdisciplinary Management of Dentofacial Deformity in Juvenile Idiopathic Arthritis. Oral Maxillofac Surg Clin North Am 2019; 32:117-134. [PMID: 31699581 DOI: 10.1016/j.coms.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Temporomandibular joint (TMJ) arthritis impacts mandibular growth and development. This can result in skeletal deformity, such as facial asymmetry and/or malocclusion asymmetry. This article reviews the unique properties of TMJ and dentofacial growth and development in the setting of juvenile idiopathic arthritis (JIA). Specific orthopedic/orthodontic and surgical management of children with JIA and TMJ arthritis is discussed. The importance of interdisciplinary collaboration is highlighted.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Section of Oral Maxillofacial Surgery, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus, Denmark
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 longwood Avenue, Boston, MA 02115, USA; Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA
| | - Shelly Abramowicz
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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22
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An Algorithm for Management of Dentofacial Deformity Resulting From Juvenile Idiopathic Arthritis: Results of a Multinational Consensus Conference. J Oral Maxillofac Surg 2019; 77:1152.e1-1152.e33. [DOI: 10.1016/j.joms.2019.02.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/28/2022]
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